Editing Infant formula

{{Short description|Manufactured food designed for feeding infants}}
{{Use mdy dates|date=May 2012}}
[[File:Infant formula.jpg|thumb|Infant formula|250x250px]]
[[File:Flaskmatning.jpeg|right|thumb|250px|An [[infant]] being fed from a [[baby bottle]]]]
'''Infant formula''', also called '''baby formula''', simply '''formula''' ([[American English]]), '''formula milk''', '''baby milk''', or '''infant milk''' ([[British English]]), is a [[processed food|manufactured food]] designed and [[marketing|marketed]] for feeding to babies and [[infants]] under 12 months of age, usually prepared for [[baby bottle|bottle]]-feeding or cup-feeding from powder (mixed with water) or liquid (with or without additional water). The U.S. [[Federal Food, Drug, and Cosmetic Act]] (FFDCA) defines infant formula as "a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of [[human milk]] or its suitability as a complete or partial substitute for human milk".<ref>U.S. Food and Drug Administration. [https://web.archive.org/web/20131214094846/http://www.fda.gov/food/foodborneillnesscontaminants/peopleatrisk/ucm108079.htm#1 What is an infant formula.]</ref>

Manufacturers state that the composition of infant formula is designed to be roughly based on a human mother's milk at approximately one to three months postpartum; however, there are significant differences in the nutrient content of these products.<ref>Wells, J.C.K. [http://www.journals.elsevierhealth.com/periodicals/ysiny/article/PIIS1084275696800170/abstract Nutritional considerations in infant formula design.] ''Seminars in Fetal & Neonatal Medicine'', 1(1): 19–26 (February 1996).</ref> The most commonly used infant formulas contain purified cow's milk [[whey]] and [[casein]] as a [[protein]] source, a blend of [[vegetable oil]]s as a fat source{{refn|group=note|As of 1915.<ref name="nap.edu#10935"/>}}, [[lactose]] as a [[carbohydrate]] source, a [[vitamin]]-mineral mix, and other ingredients depending on the manufacturer.<ref name="nap.edu#10935">{{Cite book|url=http://www.nap.edu/openbook.php?record_id=10935&page=41|title=3 Comparing Infant Formulas with Human Milk - Infant Formula: Evaluating the Safety of New Ingredients - The National Academies Press|website=nap.edu|access-date=April 3, 2018|doi=10.17226/10935|pmid=25009867|year=2004|isbn=978-0-309-09150-3 | author1 = Institute of Medicine | author2 = Food Nutrition Board| author3 = Committee on the Evaluation of the Addition of Ingredients New to Infant Formula }}</ref> Modern infant formulas also contain [[Human milk oligosaccharide|human milk oligosaccharides]], which are beneficial for immune development and a healthy gut microbiota in babies.{{Medical citation needed|date=February 2025}} In addition, there are [[Soy-based infant formula|infant formulas using soybean]] as a protein source in place of cow's milk (mostly in the United States and Great Britain) and formulas using protein hydrolysed into its component amino acids for infants who are allergic to other proteins. An upswing in [[breastfeeding]] in many countries has been accompanied by a deferment in the average age of introduction of [[baby food]]s (including cow's milk), resulting in both increased breastfeeding and increased use of infant formula between the ages of 3- and 12-months.<ref name="Fomon">{{cite conference | vauthors = Fomon SJ | title = Infant Feeding in the 20th Century: Formula and Beikost | publisher = Department of Pediatrics, College of Medicine, University of Iowa | location = San Diego, CA | year=2001 | url = http://jn.nutrition.org/cgi/content/full/131/2/409S#FN1 | access-date =September 16, 2006}}</ref><ref name="Ryan">{{cite journal | vauthors = Ryan AS | title = The resurgence of breastfeeding in the United States | journal = Pediatrics | volume = 99 | issue = 4 | pages = E12 | date = April 1997 | pmid = 9099787 | doi = 10.1542/peds.99.4.e12 | doi-access = free }}</ref>

A 2001 [[World Health Organization]] (WHO) report found that infant formula prepared in accordance with applicable [[Codex Alimentarius]] standards was a safe complementary food and a suitable breast [[milk substitute]]. In 2003, the WHO and UNICEF published their ''Global Strategy for Infant and Young Child Feeding'', which restated that "processed-food products for...young children should, when sold or otherwise distributed, meet applicable standards recommended by the Codex Alimentarius Commission", and also warned that "lack of breastfeeding—and especially lack of exclusive breastfeeding during the first half-year of life—are important risk factors for infant and childhood morbidity and mortality".

In particular, the use of infant formula in less economically developed countries is linked to poorer health outcomes because of the prevalence of unsanitary preparation conditions, including lack of clean water and lack of sanitizing equipment.<ref name="WHO">.World Health Organization. [http://whqlibdoc.who.int/publications/2003/9241562218.pdf ''Global strategy for infant and young child feeding''.] Geneva, 2003. Retrieved August 8, 2011.</ref> A formula-fed child living in unclean conditions is between 6 and 25 times more likely to die of [[diarrhea]] and four times more likely to die of [[pneumonia]] than a breastfed child.<ref name=unicef>{{cite web | title = Infant and Young Child Feeding and Care| website = UNICEF | url = http://www.unicef.org/nutrition/index_breastfeeding.html| access-date =June 8, 2007 }}</ref> Rarely, use of powdered infant formula (PIF) has been associated with serious illness, and even death, due to infection with ''[[Cronobacter sakazakii]]'' and other microorganisms that can be introduced to PIF during its production. Although ''C. sakazakii'' can cause illness in all age groups, infants are believed to be at greatest risk of infection. Between 1958 and 2006, there have been several dozen reported cases of ''C. sakazakii'' infection worldwide. The WHO believes that such infections are under-reported.<ref>World Health Organization. [https://www.who.int/foodsafety/publications/micro/pif_guidelines.pdf ''Guidelines for the safe preparation, storage and handling of powdered infant formula''.] Geneva, 2007.</ref>
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==Uses, risks and controversies==
{{See|Infant food safety}}
The use and marketing of infant formula has come under scrutiny. [[Breastfeeding]], including exclusive breastfeeding for the first 6 months of life, is widely advocated as "ideal" for babies and infants, both by health authorities<ref name="WHO"/><ref name="CDC Breastfeeding FAQ"/>—and accordingly in ethical advertising of infant formula manufacturers.<ref>{{Cite web |url=http://www.babymilk.nestle.com/FAQ/HomeFAQ.htm#question0 |title=Nestlé FAQ – Should all mothers be encouraged to breastfeed exclusively for the first 6 months? |access-date=June 1, 2009 |archive-date=May 3, 2009 |archive-url=https://web.archive.org/web/20090503161833/http://www.babymilk.nestle.com/FAQ/HomeFAQ.htm#question0 |url-status=dead }}</ref>

Despite the recommendation that babies be exclusively breastfed for the first 6 months, less than 40% of infants below this age are exclusively breastfed worldwide.<ref>World Health Organization. [https://www.who.int/child_adolescent_health/news/archive/2011/29_07_2011/en/index.html World Breastfeeding Week August 1–7, 2011.] Retrieved August 8, 2011.</ref> The overwhelming majority of American babies are not exclusively breastfed for this period—in 2005 under 12% of babies were breastfed exclusively for the first 6 months,<ref name="CDC Breastfeeding FAQ"/> with over 60% of babies of 2 months of age being fed formula,<ref>{{cite web|url=https://www.cdc.gov/ifps/results/ch3/table3-1.htm|title=Results: Breastfeeding and Infant Feeding Practices - Breastfeeding - CDC|date=December 5, 2017|website=www.cdc.gov|access-date=April 3, 2018}}</ref> and approximately one in four breastfed infants having infant formula feeding within two days of birth.<ref>{{cite web|url=https://www.cdc.gov/breastfeeding/data/NIS_data/index.htm|title=National Immunization Survey (NIS)|date=December 1, 2017|website=cdc.gov|access-date=April 3, 2018}}</ref>

Some studies have shown that use of formula can vary according to the parents' [[socio-economic status]], ethnicity or other characteristics. For example, according to a research conducted in Vancouver, Canada, 82.9% of mothers breastfeed their babies at birth, but the number differed between Caucasians (91.6%) and non-Caucasians (56.8%), with the difference essentially attributed to marital status, education and family income.<ref>{{cite journal | vauthors = Williams PL, Innis SM, Vogel AM | title = Breastfeeding and weaning practices in Vancouver | journal = Canadian Journal of Public Health | volume = 87 | issue = 4 | pages = 231–236 | year = 1996 | pmid = 8870300 }}</ref> In the United States, mothers of lower socio-economic status have been found less likely to breastfeed, although this may be partly related to adverse effects of government nutrition supplementation programs that provide subsidies for infant formula.<ref name="whopays"/>

The use of hydrolysed cow milk baby formula versus standard milk baby formula does not appear to change the risk of [[allergies]] or [[autoimmune disease]]s.<ref>{{cite journal | vauthors = Boyle RJ, Ierodiakonou D, Khan T, Chivinge J, Robinson Z, Geoghegan N, Jarrold K, Afxentiou T, Reeves T, Cunha S, Trivella M, Garcia-Larsen V, Leonardi-Bee J | display-authors = 6 | title = Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis | journal = BMJ | volume = 352 | pages = i974 | date = March 2016 | pmid = 26956579 | pmc = 4783517 | doi = 10.1136/bmj.i974 }}</ref>

===Use of infant formula===
{{Main|Breastfeeding contraindications}}
In some cases, breastfeeding is medically [[contraindicated]]; these include:
* '''Mother's health:''' The mother is infected with HIV or has active [[tuberculosis]].<ref name="CDCwhen">{{cite web | title = When should a mother avoid breastfeeding? | publisher = Centers for Disease Control and Prevention | date = August 26, 2006 | url = https://www.cdc.gov/breastfeeding/disease/contraindicators.htm | access-date =February 25, 2007 }}</ref> She is extremely ill or has had certain kinds of [[breast surgery]], which may have removed or disconnected all milk-producing parts of the breast. She is taking any kind of drug that could harm the baby, including both prescription drugs such as [[Chemotherapy|cytotoxic chemotherapy]] for cancer treatments as well as illicit drugs.<ref name="CDCwhen"/>
** One of the main global risks posed by breast milk specifically is the transmission of HIV and other infectious diseases. Breastfeeding by an HIV-infected mother poses a 5–20% chance of transmitting HIV to the baby.<ref>WHO, UNICEF, UNFPA, UNAIDS. ''HIV transmission through breastfeeding: A review of available evidence''. Geneva: World Health Organization, 2004.</ref><ref name="pmid15325535">{{cite journal | vauthors = Lawrence RM, Lawrence RA | title = Breast milk and infection | journal = Clinics in Perinatology | volume = 31 | issue = 3 | pages = 501–528 | date = September 2004 | pmid = 15325535 | pmc = 7133241 | doi = 10.1016/j.clp.2004.03.019 }}</ref><ref name="pmid15583769">{{cite journal | vauthors = Lamounier JA, Moulin ZS, Xavier CC | title = [Recommendations for breastfeeding during maternal infections] | language = pt | journal = Jornal de Pediatria | volume = 80 | issue = 5 Suppl | pages = S181–S188 | date = November 2004 | pmid = 15583769 | doi = 10.2223/jped.1252 | doi-broken-date = January 9, 2025 | doi-access = free }}</ref> However, if a mother has HIV, she is more likely to transmit it to her child during the pregnancy or birth than during breastfeeding. A 2012 study conducted by researchers from the [[University of North Carolina School of Medicine]] showed reduced HIV-1 transmission in humanized mice, due to components in the breast milk.<ref>{{cite journal | vauthors = Wahl A, Swanson MD, Nochi T, Olesen R, Denton PW, Chateau M, Garcia JV | title = Human breast milk and antiretrovirals dramatically reduce oral HIV-1 transmission in BLT humanized mice | journal = PLOS Pathogens | volume = 8 | issue = 6 | pages = e1002732 | year = 2012 | pmid = 22737068 | pmc = 3380612 | doi = 10.1371/journal.ppat.1002732 | doi-access = free }}</ref> [[Cytomegalovirus]] infection poses potentially dangerous consequences for pre-term babies.<ref name="pmid15325535"/><ref name="pmid16287195">{{cite journal | vauthors = Schleiss MR | title = Acquisition of human cytomegalovirus infection in infants via breast milk: natural immunization or cause for concern? | journal = Reviews in Medical Virology | volume = 16 | issue = 2 | pages = 73–82 | year = 2006 | pmid = 16287195 | doi = 10.1002/rmv.484 | s2cid = 31680652 }}</ref> Other risks include mother's infection with [[HTLV-1]] or [[HTLV-2]] (viruses that could cause [[T-cell leukemia]] in the baby),<ref name="pmid15325535"/><ref name="pmid15583769"/> [[herpes simplex]] when lesions are present on the breasts,<ref name="pmid15583769"/> and [[chickenpox]] in the newborn when the disease manifested in the mother within a few days of birth.<ref name="pmid15583769"/> In some cases these risks can be mitigated by using heat-treated milk and nursing for a briefer time (e.g. 6 months, rather than 18–24 months), and can be avoided by using an uninfected woman's milk, as via a wet-nurse or milk bank, or by using infant formula and/or treated milk.<ref name="contextHIV">{{cite web|url=http://www.aed.org/Publications/loader.cfm?url=/commonspot/security/getfile.cfm&pageid=1040|title=Infant Feeding Options in the Context of HIV|website=aed.org|access-date=April 3, 2018}}</ref>
** In balancing the risks, such as cases where the mother is infected with HIV, a decision to use infant formula versus exclusive breastfeeding may be made based on alternatives that satisfy the “AFASS” (Acceptable, Feasible, Affordable, Sustainable and Safe) principles.<ref name="contextHIV"/><ref>de Paoli MD, Manongi RM, Klepp KI. [http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102284289.html Infant Feeding Options Recommended for Mothers with HIV: Are they acceptable, feasible, affordable, sustainable and safe?] ''Int Conf AIDS''. 2004 Jul 11–16; 15.</ref>
* '''Baby is unable to breastfeed:''' The child has a [[birth defect]] or [[inborn error of metabolism]] such as [[galactosemia]] that makes breastfeeding difficult or impossible.<ref>{{cite web |title=Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants {{!}} Breastfeeding {{!}} CDC |url=https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/contraindications-to-breastfeeding.html |website=www.cdc.gov |access-date=23 February 2019 |language=en-us |date=24 January 2019}}</ref>
*'''Baby is considered at risk for malnutrition:''' In certain circumstances infants may be at risk for malnutrition, such as due to [[iron deficiency]], vitamin deficiencies (e.g. [[Hypovitaminosis D|vitamin D]] which may be less present in breast milk than needed at high latitudes where there is less sun exposure), or inadequate nutrition during transition to solid foods.<ref name="pmid16262018">{{cite journal | vauthors = Mamiro PS, Kolsteren P, Roberfroid D, Tatala S, Opsomer AS, Van Camp JH | title = Feeding practices and factors contributing to wasting, stunting, and iron-deficiency anaemia among 3-23-month old children in Kilosa district, rural Tanzania | journal = Journal of Health, Population, and Nutrition | volume = 23 | issue = 3 | pages = 222–230 | date = September 2005 | pmid = 16262018 }}</ref> Risks can often be mitigated with improved diet and education of mothers and caregivers, including availability of macro and micronutrients. For example, in Canada, marketed infant formulas are fortified with vitamin D, but [[Health Canada]] also recommends breastfed infants receive extra vitamin D in the form of a supplement.<ref name="hc-sc.gc.ca">{{cite web |url=http://www.hc-sc.gc.ca/fn-an/pubs/infant-nourrisson/nut_infant_nourrisson_term_3-eng.php |title=Breastfeeding is the optimal method of feeding infants.|access-date=2009-12-03 |url-status=dead |archive-url=https://web.archive.org/web/20100213003706/http://www.hc-sc.gc.ca/fn-an/pubs/infant-nourrisson/nut_infant_nourrisson_term_3-eng.php |archive-date=February 13, 2010 |df=mdy-all }}</ref>

Other reasons for not breastfeeding include:
* '''Personal preferences, beliefs, and experiences:''' The mother may dislike breast-feeding or find it inconvenient.<ref>{{cite news|url=https://www.bbc.co.uk/news/health-12008913|title=Mums who choose bottle over breastfeeding 'demonised'|author=Lee, Ellie|author-link=Ellie Lee|date=December 17, 2010|newspaper=BBC News|access-date=December 26, 2010 }}</ref> In addition, breastfeeding can be difficult for victims of rape or sexual abuse; for example, it may be a trigger for [[posttraumatic stress disorder]].<ref>{{cite web|url=http://www.pandys.org/articles/breastfeeding.html|title=Breastfeeding as a Rape or Sexual Abuse Survivor|publisher=Pandora's Project|author=Katy|year=2009|access-date=March 20, 2012|archive-date=December 29, 2011|archive-url=https://web.archive.org/web/20111229230136/http://www.pandys.org/articles/breastfeeding.html|url-status=dead}}</ref><ref>{{cite journal | vauthors = Kendall-Tackett K | title = Breastfeeding and the sexual abuse survivor | journal = Journal of Human Lactation | volume = 14 | issue = 2 | pages = 125–30; quiz 131–3 | date = June 1998 | pmid = 9775845 | doi = 10.1177/089033449801400212 | s2cid = 37288715 }}</ref> Many families bottle feed to increase the father's role in parenting his child.<ref>{{cite journal | vauthors = Earle S | title = Why some women do not breast feed: bottle feeding and fathers' role | journal = Midwifery | volume = 16 | issue = 4 | pages = 323–330 | date = December 2000 | pmid = 11080468 | doi = 10.1054/midw.2000.0222 }}<!--|access-date=March 20, 2012--></ref>
*'''Mental health:''' The pressure to breastfeed in many cultures can be so much that the mother's mental health may take a sharp decline. This can have physical effects such as poor latching as well as milk depletion and a lack of connection to the child. In some cases it is better for the child to be formula fed so that a better bond can be made between mother and child rather than the ‘special bond’ that comes from breastfeeding being tainted by negative breastfeeding experiences. The pressure to breastfeed in many cultures can increase the likelihood of [[postpartum depression]].<ref name="Breastfeeding and Postpartum Depres">{{cite journal | vauthors = Pope CJ, Mazmanian D | title = Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future Research | journal = Depression Research and Treatment | volume = 2016 | pages = 4765310 | date = 2016 | pmid = 27148457 | pmc = 4842365 | doi = 10.1155/2016/4765310 | doi-access = free }}</ref>
* '''Absence of the mother:''' The child is [[adopted]], [[orphan]]ed, abandoned, or in the sole [[child custody|custody]] of a man or male [[LGBT adoption|same-sex couple]]. The mother is separated from her child by being in prison or a [[mental hospital]]. The mother has left the child in the care of another person for an extended period of time, such as while traveling or working abroad.
* '''Food allergies''': The mother eats foods that may provoke an allergic reaction in the infant.{{citation needed|date=August 2011}}
* '''Financial pressures:''' [[Maternity leave]] is unpaid, insufficient, or lacking. The mother's employment interferes with breastfeeding.<ref name="chen effects">{{cite journal | vauthors = Chen YC, Wu YC, Chie WC | title = Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey | journal = BMC Public Health | volume = 6 | pages = 160 | date = June 2006 | pmid = 16787546 | pmc = 1538587 | doi = 10.1186/1471-2458-6-160 | doi-access = free }}</ref> Mothers who breastfeed may experience a loss of earning power.<ref>{{cite news| vauthors = Dell'Antonai KJ |title=The True Cost of Breast-feeding — This Milk Isn't Free|url=https://parenting.blogs.nytimes.com/2012/04/03/the-true-cost-of-breast-feeding-this-milk-isnt-free/|access-date=15 September 2017|newspaper=The New York Times|date=3 April 2012}}</ref>
* '''Societal structure:''' Breastfeeding may be forbidden, discouraged or difficult at the mother's job, school, place of worship or in other public places, or the mother may feel that breastfeeding in these places or around other people is immodest, unsanitary, or inappropriate.<ref name="chen effects"/>
* '''Social pressures:''' Family members, such as mother's husband or boyfriend, or friends or other members of society may encourage the use of infant formula. For example, they may believe that breastfeeding will decrease the mother's energy, health, or attractiveness. {{citation needed|date=September 2015}} <ref>{{cite web|title=The Surgeon General's Call to Action to Support Breastfeeding|url=https://www.ncbi.nlm.nih.gov/books/NBK52688/|website=NCBI|access-date=15 September 2017}}</ref> Conversely, societal pressures to breastfeed can also lead to mental health issues. A sense of shame from not being able to or struggling to do so equalling being a failure has a connection to Postpartum Depression<ref name="Breastfeeding and Postpartum Depres"/> 
* '''Lack of training and education:''' The mother lacks education and training from medical providers or community members. {{citation needed|date=September 2015}} <ref name="BMJ 2007;335:596">{{cite journal | vauthors = Su LL, Chong YS, Chan YH, Chan YS, Fok D, Tun KT, Ng FS, Rauff M | display-authors = 6 | title = Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial | journal = BMJ | volume = 335 | issue = 7620 | pages = 596 | date = September 2007 | pmid = 17670909 | pmc = 1989016 | doi = 10.1136/bmj.39279.656343.55 }}</ref>
* '''Lactation insufficiency:''' The mother is unable to produce sufficient milk. In studies that do not account for lactation failure with obvious causes (such as use of formula and/or breast pumps), chronic lactation insufficiency affects around 10–15% of women.<ref>{{Cite journal |last1=Lee |first1=Sooyeon |last2=Kelleher |first2=Shannon L. |date=2016-08-01 |title=Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology |journal=American Journal of Physiology. Endocrinology and Metabolism |volume=311 |issue=2 |pages=E405–E422 |doi=10.1152/ajpendo.00495.2015 |issn=0193-1849 |pmc=5005964 |pmid=27354238}}</ref> For about 5–8% of women, milk coming in (i.e., lactogenesis II) may not occur at all, and only drops are produced.<ref>{{Cite journal |last1=Feldman-Winter |first1=Lori |last2=Kellams |first2=Ann |last3=Peter-Wohl |first3=Sigal |last4=Taylor |first4=Julie Scott |last5=Lee |first5=Kimberly G. |last6=Terrell |first6=Mary J. |last7=Noble |first7=Lawrence |last8=Maynor |first8=Angela R. |last9=Meek |first9=Joan Younger |last10=Stuebe |first10=Alison M. |date=2020-04-01 |title=Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥35 Weeks |journal=Pediatrics |volume=145 |issue=4 |pages=e20183696 |doi=10.1542/peds.2018-3696 |pmid=32161111 |s2cid=212679436 |issn=0031-4005|doi-access=free }}</ref> Alternatively, despite a healthy supply, the woman or her family may incorrectly believe that her breast milk is of low quality or in low supply. These women may choose infant formula either exclusively or as a supplement to breastfeeding. {{citation needed|date=September 2015}} New research is showing that mothers who report problems with milk production have physical markers indicating low milk production, calling into question the assumption (called “perceived insufficient milk supply” or PIMS) that mothers are incorrect about the quantity of milk they are producing.<ref>{{Cite journal |last1=Murase |first1=Masahiko |last2=Wagner |first2=Erin A. |last3=Chantry |first3=Caroline J. |last4=Dewey |first4=Kathryn G. |last5=Nommsen-Rivers |first5=Laurie A. |date=2017-02-01 |title=The Relation between Breast Milk Sodium to Potassium Ratio and Maternal Report of a Milk Supply Concern |url=https://www.jpeds.com/article/S0022-3476(16)31177-5/abstract |journal=The Journal of Pediatrics |language=English |volume=181 |pages=294–297.e3 |doi=10.1016/j.jpeds.2016.10.044 |issn=0022-3476 |pmc=5274566 |pmid=27871690}}</ref><ref>{{Cite journal |last1=Rivera |first1=Olivia C. |last2=Geddes |first2=Donna T. |last3=Barber-Zucker |first3=Shiran |last4=Zarivach |first4=Raz |last5=Gagnon |first5=Annie |last6=Soybel |first6=David I. |last7=Kelleher |first7=Shannon L. |date=2020-06-01 |title=A common genetic variant in zinc transporter ZnT2 (Thr288Ser) is present in women with low milk volume and alters lysosome function and cell energetics |journal=American Journal of Physiology. Cell Physiology |volume=318 |issue=6 |pages=C1166–C1177 |doi=10.1152/ajpcell.00383.2019 |pmid=32320289 |s2cid=216082748 |issn=0363-6143|doi-access=free }}</ref>
*'''Fear of exposure to environmental contaminants:''' Certain environmental pollutants, such as [[polychlorinated biphenyls]], can bioaccumulate in the food chain and may be found in humans including mothers' breast milk.<ref name="pmid11065082">{{Cite book|vauthors=Przyrembel H, Heinrich-Hirsch B, Vieth B |title=Short and Long Term Effects of Breast Feeding on Child Health |chapter=Exposition to and Heal Theffects of Residues in Human Milk|volume=478|pages=307–25|pmid=11065082|doi=10.1007/0-306-46830-1_27|series=Advances in Experimental Medicine and Biology|date=2002 |isbn=978-0-306-46405-8}}</ref>
** However studies have shown that the greatest risk period for adverse effects from environmental exposures is prenatally.<ref name="pmid11065082"/> Other studies have further found that the levels of most persistent [[organohalogen]] compounds in human milk decreased significantly over the past three decades and equally did their exposure through breastfeeding.<ref>Fürst P. [http://onlinelibrary.wiley.com/doi/10.1002/mnfr.200600008/abstract Dioxins, polychlorinated biphenyls and other organohalogen compounds in human milk. Levels, correlations, trends and exposure through breastfeeding.] ''Molecular Nutrition & Food Research'', 50(10): 922–933, October 2006.</ref>
**Research on risks from chemical pollution is generally inconclusive in terms of outweighing the benefits of breastfeeding.<ref name="NRDC">{{cite web|url=http://www.nrdc.org/breastmilk/chem9.asp|title=Healthy Milk, Healthy Baby&nbsp;– Chemical Pollution and Mother's Milk&nbsp;– Chemicals: Dioxins and Furans|website=nrdc.org|access-date=April 3, 2018}}</ref><ref name="rogan" /> Studies supported by the WHO and others have found that neurological benefits of breast milk remain, regardless of dioxin exposure.<ref name="rogan">{{cite journal | vauthors = Rogan WJ, Blanton PJ, Portier CJ, Stallard E | title = Should the presence of carcinogens in breast milk discourage breast feeding? | journal = Regulatory Toxicology and Pharmacology | volume = 13 | issue = 3 | pages = 228–240 | date = June 1991 | pmid = 1947235 | doi = 10.1016/0273-2300(91)90065-4 }}– cited in NRDC</ref><ref>Brouwer, A., et al. Report of the WHO Working Group on the Assessment of Health Risks for Human Infants from Exposure to PCDDs, PCDFs and PCBs, ''Chemosphere'' 1998; 37(9–12): pp.&nbsp;1627–1643. – cited in NDRC</ref> 
**In developing countries, environmental contaminants associated with increased health risks from use of infant formula, particularly diarrhea due to unclean water and lack of sterile conditions – both prerequisites to the safe use of formula – often outweigh any risks from breastfeeding.
* '''Lack of other sources of breast milk:'''
** ''Lack of wet nurses:'' [[Wet nursing]] is illegal and stigmatized in some countries, and may not be available.<ref>{{cite web|url=https://www.theguardian.com/society/2007/jan/05/health.medicineandhealth|title=Viv Groskop on women who breastfeed other people's babies| vauthors = Groskop V |date=January 5, 2007|website=The Guardian|access-date=April 3, 2018}}</ref> It may also be socially unsupported, expensive, or health screening of wet nurses may not be available. The mother, her doctor,<ref>[http://www.mayoclinic.com/health/breast-feeding/FL00133 "Breast-feeding and Guilt: Interview with a Mayo Clinic Specialist"]<!-- To clarify a perhaps unclear reference, this is to illustrate that American doctors at respected clinics may not mention the WHO recommendations of expressed breast milk, wet nursing, or milk banking. --></ref> or family may not know that wet nursing is possible, or may believe that nursing by a relative or paid wet-nurse is unhygienic.
** ''Lack of milk banks:'' [[Human-milk bank]]s may not be available, as few exist, and many countries cannot provide the necessary screening for diseases and refrigeration.

===Health risks===
Use of infant formula has been cited for association with numerous increased health risks. Studies have found infants in developed countries who consume formula are at increased risk for acute [[otitis media]], [[gastroenteritis]], severe lower respiratory tract infections, atopic [[dermatitis]], [[asthma]], [[obesity]],<ref>{{cite journal | vauthors = Melnik BC | title = Excessive Leucine-mTORC1-Signalling of Cow Milk-Based Infant Formula: The Missing Link to Understand Early Childhood Obesity | journal = Journal of Obesity | volume = 2012 | pages = 197653 | date = 2012-01-01 | pmid = 22523661 | pmc = 3317169 | doi = 10.1155/2012/197653 | doi-access = free }}</ref> type 1 and 2 [[diabetes]], [[sudden infant death syndrome]] (SIDS), [[eczema]] and [[necrotizing enterocolitis]] when compared to infants who are breastfed.<ref name="AHRQ-Tufts">{{cite journal | vauthors = Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J | display-authors = 6 | title = Breastfeeding and maternal and infant health outcomes in developed countries | journal = Evidence Report/Technology Assessment | issue = 153 | pages = 1–186 | date = April 2007 | pmid = 17764214 | pmc = 4781366 | isbn = 9781587632426 | url = https://archive.org/details/breastfeedingmat00ipst | url-access = registration }}</ref><ref name="pmid9233193">{{cite journal | vauthors = Riordan JM | title = The cost of not breastfeeding: a commentary | journal = Journal of Human Lactation | volume = 13 | issue = 2 | pages = 93–97 | date = June 1997 | pmid = 9233193 | doi = 10.1177/089033449701300202 | s2cid = 27447579 }}</ref><ref name="pmid15037991">{{cite journal | vauthors = Sadauskaite-Kuehne V, Ludvigsson J, Padaiga Z, Jasinskiene E, Samuelsson U | title = Longer breastfeeding is an independent protective factor against development of type 1 diabetes mellitus in childhood | journal = Diabetes/Metabolism Research and Reviews | volume = 20 | issue = 2 | pages = 150–157 | year = 2004 | pmid = 15037991 | doi = 10.1002/dmrr.425 | s2cid = 41423626 }}</ref><ref name="pmid6734490">{{cite journal | vauthors = Pratt HF | title = Breastfeeding and eczema | journal = Early Human Development | volume = 9 | issue = 3 | pages = 283–290 | date = April 1984 | pmid = 6734490 | doi = 10.1016/0378-3782(84)90039-2 }}</ref> Some studies have found an association between infant formula and lower [[cognitive development]], including iron supplementation in baby formula being linked to lowered [[I.Q.]] and other neurodevelopmental delays;<ref name="pmid16087970">{{cite journal | vauthors = McCann JC, Ames BN | title = Is docosahexaenoic acid, an n-3 long-chain polyunsaturated fatty acid, required for development of normal brain function? An overview of evidence from cognitive and behavioral tests in humans and animals | journal = The American Journal of Clinical Nutrition | volume = 82 | issue = 2 | pages = 281–295 | date = August 2005 | pmid = 16087970 | doi = 10.1093/ajcn.82.2.281 | doi-access = free }}</ref><ref name="Kerr1">{{cite news| vauthors = Kerr M, Lie D | title = Neurodevelopmental Delays Associated With Iron-Fortified Formula for Healthy Infants | work = Medscape Psychiatry and Mental Health| year = 2008| url = https://www.medscape.com/viewarticle/574363| access-date =August 4, 2008 }}</ref> however other studies have found no correlation.<ref name="AHRQ-Tufts"/> Causation, however, has not been established for negative long-term health effects of infant formula; studies analyzing health outcomes for breastfed vs. formula fed babies are primarily observational in nature and are plagued with confounding factors such as socioeconomic status, education level, and maternal preexisting conditions (such as obesity, which is associated with both low milk production and childhood obesity). When confounding factors are controlled for, differences between long-term health of breastfed and formula fed infants decrease.<ref>{{Cite web |title=Is the "breast is best" mantra an oversimplification? |url=https://www.mdedge.com/clinicianreviews/article/166932/pediatrics/breast-best-mantra-oversimplification |access-date=2022-03-12 |website=www.mdedge.com |language=en}}</ref>

====Melamine contamination====
{{Main|2008 Chinese milk scandal}}
In 2008, a case of melamine poisoning of infant formula was discovered in [[China]], where milk was deliberately adulterated with the chemical, leading to the death of six babies, and illnesses in more than 300,000 infants, including cases of [[acute kidney failure]]. Large quantities of melamine were added to watered-down milk to give it the appearance of having adequate protein levels. Some of those responsible for the poisoning were sentenced to death.<ref name="theglobeandmail.com"/>

In November 2008, traces of [[melamine]] were reported to have been found by the U.S. [[Food and Drug Administration]] in infant formula sold in the United States made by the three main American firms<ref name="AP">{{cite web | url = http://www.ap.org/FOI/foi_112608b.htm | title= FDA Finds Traces Of Melamine In US Infant Formula | website= [[Associated Press]] | archive-url = https://web.archive.org/web/20110711215534/http://ap.org/FOI/foi_112608b.htm | archive-date = July 11, 2011 }}, posted by [[Associated Press]], November 26, 2008.</ref><ref>[http://www.nbcnews.com/id/27914218 Calls for national infant formula recall spread: Worried parents look for guidance after traces of melamine found], posted by NBC News, November 26, 2008.</ref> — [[Abbott Laboratories]], [[Nestlé]] and [[Mead Johnson]] — responsible for 90–99% of the infant formula market in that country.<ref name="whopays"/><ref name="AP"/> The levels were much less than those reported in China, where levels of melamine contamination had reached as much as 2,500 parts per million, about 10,000 times higher than the recorded US levels. The [[safety data sheet]] for melamine ([[CAS registry number]] 108-78-1; C3-H6-N6) recorded the acute oral toxicity ([[median lethal dose]]) at 3161&nbsp;mg/kg for a rat.

[[Health Canada]] conducted a separate test and also detected traces of melamine in infant formula available in Canada. The melamine levels were well below Health Canada's safety limits,<ref>Health Canada. [http://hc-sc.gc.ca/fn-an/securit/chem-chim/melamine/qa-melamine-qr-eng.php Questions and Answers – Melamine.] Retrieved August 9, 2011.</ref> although concerns remain about the safety of manufactured food for infants and monitoring of potentially dangerous substances.<ref name="theglobeandmail.com">[https://www.theglobeandmail.com/report-on-business/international-news/global-exchange/chinese-news-media-step-up-efforts-in-fight-for-food-safety/article2026156/ Chinese news media step up efforts in fight for food safety] {{Webarchive|url=https://web.archive.org/web/20161013145209/http://www.theglobeandmail.com/report-on-business/international-news/global-exchange/chinese-news-media-step-up-efforts-in-fight-for-food-safety/article2026156/ |date=October 13, 2016 }}, ''The Globe and Mail'', posted May 18, 2011.</ref>

====Other health controversies====
* In 1985, [[Syntex Corporation]] was ordered to pay $27 million in compensation for the deaths of two American infants who suffered brain damage after drinking the company's baby formula, called ''Neo-mull-soy''.<ref>{{cite news |vauthors=Mount C |title=$27 Million for 2 Victims |url=https://pqasb.pqarchiver.com/chicagotribune/access/25099431.html?dids=25099431:25099431&FMT=ABS&FMTS=ABS:FT&date=Mar+01%2C+1985&author=Charles+Mount&pub=Chicago+Tribune+(pre-1997+Fulltext)&desc=%2427+MILLION+FOR+2+VICTIMS+OF+BABY+FORMULA&pqatl=google |quote=were given the baby formula, called Neo-mull-soy, when they were infants ... In 1978, Syntex eliminated salt from the formula, a move that Hayes said caused ... |work=Chicago Tribune |date=March 1, 1985 |access-date=April 23, 2009 |archive-date=October 20, 2012 |archive-url=https://web.archive.org/web/20121020081548/http://pqasb.pqarchiver.com/chicagotribune/access/25099431.html?dids=25099431:25099431&FMT=ABS&FMTS=ABS:FT&date=Mar+01,+1985&author=Charles+Mount&pub=Chicago+Tribune+(pre-1997+Fulltext)&desc=$27+MILLION+FOR+2+VICTIMS+OF+BABY+FORMULA&pqatl=google |url-status=dead }}</ref> Formulas produced by Syntex had previously been subject to a major recall as they were found to have insufficient chloride to support normal infant growth and development.<ref>[http://leda.law.harvard.edu/leda/data/823/Goedert_07.html The Syntex Problem] {{webarchive|url=https://web.archive.org/web/20110927172129/http://leda.law.harvard.edu/leda/data/823/Goedert_07.html |date=September 27, 2011 }}, by Robert Goedert, Harvard Law School, May 2007.</ref>
* In 2003, baby plant-based formula manufactured by the German company ''Humana'' and sold in Israel under the brand ''Remedia'' caused severe vitamin deficiencies in babies. Babies who consumed the formula were hospitalized with cardiac and neurological symptoms. Three of them died, and at least twenty others were left with severe disabilities. An investigation revealed that the formula contained a much lower quantity of [[Thiamine]] than is needed for healthy infant development because of a manufacturing error. Humana's chief food technologist received a 30-month prison sentence for negligent manslaughter in February 2013 over the case.<ref>{{cite web|url=http://www.timesofisrael.com/study-of-israeli-baby-formula-tragedy-highlights-vital-vitamin-b1-role/|title=Study of Israeli baby formula tragedy highlights vital vitamin B1 role|website=The Times of Israel|access-date=April 3, 2018}}</ref>
* In 2010, [[Abbott Laboratories]] issued a voluntary recall of about five million ''Similac'' brand powder infant formulas that were sold in the United States, Guam, Puerto Rico and some Caribbean countries. The recall was issued after the presence of a 'small common [[beetle]]' was detected in the product.<ref>[http://www.abbott.com/global/url/pressRelease/en_US/60.5:5/Press_Release_0900.htm Abbott Voluntarily Recalls Certain Similac® Brand Powder Infant Formulas] {{Webarchive|url=https://web.archive.org/web/20111021063012/http://www.abbott.com/global/url/pressRelease/en_US/60.5:5/Press_Release_0900.htm |date=October 21, 2011 }}, Abbott Press Release, issued September 22, 2010.</ref>
*In Canada, New Zealand and elsewhere, public concerns have been raised over the continued sale and marketing of soy-based formulae potentially containing high levels of [[phytoestrogens]],<ref>INFACT Canada. [http://www.infactcanada.ca/genetic.htm Genetic engineering and infant foods.]</ref><ref>World Alliance for Breastfeeding Action. [https://www.waba.org.my/whatwedo/environment/penny_infants.htm Infant Feeding Products.]</ref> linked to abnormal child development<ref>Aksglaede L. [http://www.healthcoalition.ca/archive/hormones2006.pdf The sensitivity of the child to sex steroids: possible impact of exogenous estrogens.] {{webarchive|url=https://web.archive.org/web/20110927084213/http://www.healthcoalition.ca/archive/hormones2006.pdf |date=September 27, 2011 }} ''Human Reproduction Update'', Advance Access published May 2, 2006.</ref> including damage to babies' thyroid glands.
*In December 2011 Wal-Mart recalled a quantity of infant formula after a baby died in Missouri. "We extend our deepest condolences to this baby boy's family as they try to come to grips with their loss," said Dianna Gee, a Wal-Mart spokeswoman. "As soon as we heard what happened, we immediately reached out to the manufacturer of the formula and to the Department of Health and Senior Services to provide any information we may have to help with the investigation." Wal-Mart said it pulled a batch of Enfamil from its stores nationwide that matched the size and lot number ZP1k7G of the formula that may have sickened the baby in Missouri, Gee said. The baby formula was purchased from a Wal-Mart in Lebanon, Missouri. After the purchase, a 10-day-old infant died from a rare bacterial infection, CNN affiliate KYTV reported. Authorities ran tests to determine if the death came from the formula, the water to make the formula or any other factor, said Mead Johnson Nutrition, the company that makes Enfamil. "We are highly confident in the safety and quality of our products – and the rigorous testing we put them through," said Chris Perille, a Mead Johnson Nutrition spokesman.[Source CNN]

==Preparation and content==

===Variations===
Infant formulas come in powder, liquid concentrate, and ready-to-feed forms. They are designed to be prepared by the parent or caregiver in small batches and fed to the infant, usually with either a cup or a [[baby bottle]].<ref name="WHO"/>

Infant formulas come in a variety of types:
*Cow's milk formula is the most commonly used type. The milk has been altered to resemble breast milk. 
*[[Soy-based infant formula|Soy protein based formulas]] are frequently used for infants allergic to cow's milk or lactose. Soy-based formulas can also be useful if the parent wants to exclude animal proteins from the child's diet.
*Protein hydrolysate formulas contain protein that's been broken down into smaller sizes than are those in cow's milk and soy-based formulas. Protein hydrolysate formulas are meant for babies who do not tolerate cow's milk or soy-based formulas. 
*Specialized formulas are also available for premature infants and those with specific medical conditions.<ref name="Mayo Clinic">{{cite web | url=https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/infant-formula/art-20045782 | title=Infant formula: Your questions answered | publisher=Mayo Clinic | access-date=7 October 2015 | author=Mayo Clinic staff}}</ref>

Manufacturers and health officials advise it is very important to measure powders or concentrates accurately to achieve the intended final product concentration; otherwise, the child will be malnourished. It is advisable that all equipment that comes into contact with the infant formula be cleaned and sterilized before each use. Proper [[refrigeration]] is essential for any infant formula which is prepared in advance.

In developing countries, formula is frequently prepared improperly, resulting in high infant mortality due to [[malnutrition]] and diseases such as [[diarrhea]] and [[pneumonia]]. This is due to lack of clean water, lack of sterile conditions, lack of refrigeration, illiteracy (so written instructions cannot be followed), poverty (diluting formula so that it lasts longer), and lack of education of mothers by formula distributors. These problems and resulting disease and death are a key factor in opposition to the marketing and distribution of infant formula in developing countries by numerous [[public health]] agencies and NGOs (discussed in more detail at [[Nestlé boycott]] and [[International Code of Marketing of Breast-milk Substitutes]]).

===Nutritional content===
Besides breast milk, infant formula is the only other milk product which the medical community considers nutritionally acceptable for infants under the age of one year (as opposed to cow's milk, goat's milk, or follow-on formula). Supplementing with [[baby food|solid food]] in addition to breast milk or formula begins during [[weaning]], and most babies begin supplementing about the time their first teeth appear, usually around the age of six months.

Although cow's milk is the basis of almost all infant formula, plain cow's milk is unsuited for infants because of its high [[casein]] content and low [[whey]] content, and untreated cow's milk is not recommended before the age of 12 months. The infant intestine is not properly equipped to digest non-human milk, and this may often result in diarrhea, intestinal bleeding and malnutrition.<ref>{{cite journal | vauthors = Jiang T, Jeter JM, Nelson SE, Ziegler EE | title = Intestinal blood loss during cow milk feeding in older infants: quantitative measurements | journal = Archives of Pediatrics & Adolescent Medicine | volume = 154 | issue = 7 | pages = 673–678 | date = July 2000 | pmid = 10891018 | doi = 10.1001/archpedi.154.7.673 | doi-access = free }}</ref> To reduce the negative effect on the infant's digestive system, cow's milk used for formula undergoes processing to be made into infant formula. This includes steps to make protein more easily digestible and alter the [[whey]]-to-[[casein]] protein balance to one closer to human milk, the addition of several essential ingredients (often called "fortification", see below), the partial or total replacement of dairy fat with fats of vegetable or marine origin, etc.

Carbohydrates are an important source of energy for growing infants, as they account for 35 to 42% of their daily energy intake. In most cow's milk-based formulas, [[lactose]] is the main source of carbohydrates present, but lactose is not present in cow's milk-based lactose-free formulas nor specialized non-milk protein formulas or [[hydrolyzed protein]] formulas for infants with milk protein sensitivity. Lactose is also not present in soy-based formulas. Therefore, those formulas without lactose will use other sources of carbohydrates, such as sucrose and [[glucose]], dextrins, and natural and modified [[starch]]es. Lactose is not only a good source of energy, it also aids in the absorption of the minerals magnesium, calcium, zinc and iron.<ref name="carb">Schmidl, M.K., Labuza, T.P. (2000).[https://books.google.com/books?id=Yp44IzX8hVAC&pg=PP1 "Infant formula and Medical Foods. In Essential of Functional Foods".] Aspen Publishers. pp.&nbsp;137–164. Google Book Search. Retrieved on November 7, 2009.</ref>

The nutrient content of infant formula for sale in the United States is regulated by the [[Food and Drug Administration]] (FDA) based on recommendations by the [[American Academy of Pediatrics]] Committee on Nutrition. The following must be included in all formulas produced in the U.S.:<ref name=21cfr107.100>{{CodeFedReg |21|107|100|accessdate=September 29, 2024}}</ref>
*[[Protein]]
*[[Fat]]
*[[Linoleic acid]]
*[[Vitamin]]s: [[vitamin A|A]], [[vitamin C|C]], [[vitamin D|D]], [[vitamin E|E]], [[vitamin K|K]], [[thiamin]] (B<sub>1</sub>), [[riboflavin]] (B<sub>2</sub>), [[vitamin B6|B<sub>6</sub>]], [[vitamin B12|B<sub>12</sub>]], [[Niacin (nutrient)|niacin]], [[folic acid]], [[pantothenic acid]]
*[[Mineral (nutrient)|Mineral]]s: [[calcium]], [[magnesium]], [[iron]], [[zinc]], [[manganese]], [[copper]], [[iodine]], [[selenium]], [[sodium]], [[potassium]], [[chloride]]

Non-milk-based formulas must also add the vitamins [[biotin]], [[choline]] and [[inositol]].

Additionally, manufacturers may choose to add additional ingredients to their formulas. These additional ingredients are often used to differentiate their products in the market, as the nutrient composition of formulas is otherwise highly similar between products.<ref name="c891">{{cite web | title=Baby & toddler, Feeding articles & support | website=NCT (National Childbirth Trust) | date=2011-05-28 | url=https://www.nct.org.uk/baby-toddler/feeding/early-days/whats-best-kind-formula-milk | access-date=2024-09-29}}</ref> Not all additives are clearly beneficial according to current studies, either because no benefit has actually been demonstrated, or because the additives are too new to have received significant scientific scrutiny.

*[[Omega-3 fatty acid]]s
**Omega-3 fatty acids, such as [[docosahexaenoic acid|DHA]], are often added to infant formula, purportedly to support brain development, although studies have generally failed to find a significant effect on neurodevelopmental outcomes.<ref name="j166">{{cite journal | last1=Jasani | first1=Bonny | last2=Simmer | first2=Karen | last3=Patole | first3=Sanjay K | last4=Rao | first4=Shripada C | title=Long chain polyunsaturated fatty acid supplementation in infants born at term | journal=Cochrane Database of Systematic Reviews | publisher=Wiley | volume=2017 | issue=3 | date=2017-03-10 | pages=CD000376 | issn=1465-1858 | doi=10.1002/14651858.cd000376.pub4 | doi-access=free | pmid=28281303 | pmc=6464574 }}</ref> Infants can synthesize DHA and other fatty acids from the linoleic acid in formula. As formula additives, these fatty acids are often derived from [[fish oil]] or similar sources.

*[[Human milk oligosaccharide]]s (HMOs)
**HMOs are naturally occurring sugars found in human breast milk, and may work to improve the immune system and act as nutrients for beneficial gut bacteria.<ref>{{cite journal | vauthors = Bode L | title = Human milk oligosaccharides: every baby needs a sugar mama | journal = Glycobiology | volume = 22 | issue = 9 | pages = 1147–1162 | date = September 2012 | pmid = 22513036 | pmc = 3406618 | doi = 10.1093/glycob/cws074 }}</ref> However, while human breastmilk contains dozens of different types of HMOs, commercial infant formula usually only includes a few of the more common types.

*[[Nucleotides]]
** Nucleotides are compounds found naturally in human breast milk. They are involved in critical metabolic processes, such as energy metabolism and enzymatic reactions. Also, as the building blocks of deoxyribonucleic acid (DNA) and ribonucleic acid (RNA), they are essential for normal body functions. Compared to human breast milk, cow's milk has lower levels of the nucleotides uridine, inosine, and cytidine. Therefore, several companies that produce infant formula have added nucleotides to their infant formulas.<ref name=carb/>

Other commonly used ingredients:
*[[Emulsifiers]] and [[stabilizer (food)|stabilizer]]s: Ingredients added to prevent the separation of the oil from the water (and its soluble components) in the infant formula. Some commonly used emulsifiers include monoglycerides, diglycerides, and gums.<ref name=two>Blachford, Ed. Cengage, G. [http://www.enotes.com/how-products-encyclopedia/baby-formula “Baby Formula”] {{Webarchive|url=https://web.archive.org/web/20111030020841/http://www.enotes.com/how-products-encyclopedia/baby-formula |date=October 30, 2011 }}, eNotes.com, November 3, 2009 <!--accessed Nov,16, 2009--></ref>
*[[Diluent]]s: [[Skimmed milk|Skim milk]] is commonly used as the primary diluent in milk-based liquid formula to provide the bulk of the volume. In contrast, purified water is the most commonly used diluent in milk-free formulations.<ref name="two" />

==Policy, industry and marketing==
The policy, regulatory and industry environments surrounding the infant formula market vary tremendously between countries.

===International===
{{Main|International Code of Marketing of Breast-milk Substitutes}}
{{See also|Nestlé boycott}}

The [[International Code of Marketing of Breast-milk Substitutes]] is an international [[health policy]] framework adopted by the [[World Health Assembly]] of the [[WHO]] in 1981 regarding infant formula marketing, including strict restrictions on advertising.<ref name="ICMBS"/> Its implementation depends on the laws of different countries and the behavior of infant formula manufacturers – the code has no power itself. Legislation and corporate behavior vary significantly between countries: at least 84 countries have enacted national legislation implementing all or many of the provisions of the Code and 14 countries have draft laws awaiting adoption;<ref>UNICEF. [http://www.unicef.org/nutrition/index_24805.html International Code of Marketing of Breast-milk Substitutes.] {{Webarchive|url=https://web.archive.org/web/20171212070106/https://www.unicef.org/nutrition/index_24805.html |date=December 12, 2017 }} Retrieved August 9, 2011.</ref> whereas elsewhere neither the Code nor its principles are followed by governments or formula manufacturers.

Practices that are banned in the Code include most advertising, claiming health benefits for formula, and giving [[Product sample|free samples]] to women able to breastfeed – this latter practice is particularly criticized because it can interfere with lactation, creating dependence on formula, without proper education on ensuring continued breast stimulation while formula is being used. In many countries free samples of infant formula have been provided to hospitals for decades; infant formula is often the only product routinely provided free of charge to hospitals.<ref>Counseling the nursing mother, By Judith Lauwers, Anna Swisher, [https://books.google.com/books?id=crW6348Iw_wC&pg=PA597 p. 597]</ref> The [[Baby Friendly Hospital Initiative]] (BFHI) aims to reduce and eliminate this controversial practice; however, there is increasing criticism of the BFHI's rigidity in limiting use of infant formula, which can be an appropriate treatment for common conditions such as suboptimal intake jaundice, and may cause mothers to feel pressured or guilted into breastfeeding.<ref>{{Cite journal |last=Wilde |first=Vera K |date=2021-10-04 |title=Breastfeeding Insufficiencies: Common and Preventable Harm to Neonates |journal=Cureus |volume=13 |issue=10 |pages=e18478 |language=en |doi=10.7759/cureus.18478 |doi-access=free |issn=2168-8184 |pmc=8491802 |pmid=34659917}}</ref><ref>{{Cite journal |last1=Howard |first1=Tera F. |last2=Hinten |first2=Brittany |last3=Ott |first3=Corilyn Mae |last4=Ye |first4=Yuanfan |last5=Tita |first5=Alan T.N. |date=2022-01-01 |title=What Women Really Think About Breastfeeding and Breast Pumping: A Qualitative Analysis of Women Who Deliver at a Baby-Friendly Hospital |url=https://www.liebertpub.com/doi/10.1089/bfm.2021.0135 |journal=Breastfeeding Medicine |volume=17 |issue=1 |pages=65–71 |doi=10.1089/bfm.2021.0135 |pmid=34919409 |s2cid=245279889 |issn=1556-8253|url-access=subscription }}</ref><ref>{{Cite journal |last1=Flaherman |first1=Valerie |last2=Von Kohorn |first2=Isabelle |date=2016-10-25 |title=Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms |url=http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.15083 |journal=JAMA |language=en |volume=316 |issue=16 |pages=1685–1687 |doi=10.1001/jama.2016.15083 |pmid=27784077 |issn=0098-7484|url-access=subscription }}</ref>

===By country===

====Philippines====
Infant formula is one of the top three consumer commodities in the Philippines, and among the most imported products.<ref name="milkwars">[https://globalvoicesonline.org/2007/07/11/milk-wars-in-the-philippines-breastmilk-versus-infant-formula/ Milk wars in the Philippines: Breastmilk versus Infant Formula], ''Global Voices'', posted July 11, 2007.</ref> Annual sales amount to some US$469 million annually. US$88 million is spent on advertising the product.<ref name=ATrirr>Cher S Jimenez, [https://web.archive.org/web/20071011113818/http://atimes.com/atimes/Southeast_Asia/IG25Ae01.html Spilled corporate milk in the Philippines], ''Asia Times Online'', July 25, 2007, Retrieved 22 December 2008.</ref>

Infant formula marketing has been regulated since the 1987 Executive Order 51 or "Milk Code",<ref name="milkcode" /> which regulated, but did not ban, practices such as advertising and providing free samples. Shortly after it was enacted, [[Wyeth]] introduced "follow-on formula", which was not in the purview of the Milk Code which predated its market entry.

In 2006, the [[Department of Health (Philippines)|Department of Health]] banned the advertising of infant formula and the practice of providing free samples, regardless of intended age group (in the ''Revised Implementing Rules and Regulations'' of Executive Order 51, or RIRR).<ref name="UNICEF-P">UNICEF Philippines. [http://www.unicef.org/philippines/news/061101.html Breastfeeding advocates form consolidated action against formula companies.] {{Webarchive|url=https://web.archive.org/web/20100710002946/http://www.unicef.org/philippines/news/061101.html |date=July 10, 2010 }} Makati City, November 13, 2006. Retrieved August 9, 2011.</ref> The new regulation was challenged by the infant formula industry in the Supreme Court. Initially the challenge was dismissed, but this decision was reversed following industry pressure and a controversial letter by American business leader Thomas Donahue,<ref>{{cite web|url=http://pcij.org/blog/wp-docs/US_Chamber_of_Commerce_Letter.pdf|title=Letter by Thomas Donahue, August 11, 2006|website=pcij.org|access-date=April 3, 2018|archive-date=November 8, 2016|archive-url=https://web.archive.org/web/20161108053124/http://pcij.org/blog/wp-docs/US_Chamber_of_Commerce_Letter.pdf|url-status=dead}}</ref> then President and CEO of the [[United States Chamber of Commerce|US Chamber of Commerce]], resulting in the regulation being suspended and advertising continuing.<ref name="milkwars"/><ref name="milkcode">{{cite web|url=http://www.pcij.org/blog/?p=1789|title=The Philippine Milk Code: A timeline|date=June 20, 2007|website=pcij.org|access-date=April 3, 2018|archive-url=https://web.archive.org/web/20100825211915/http://www.pcij.org/blog/?p=1789|archive-date=August 25, 2010|url-status=dead}}</ref><ref name="UNICEF-P"/><ref>{{cite web|url=http://www.pcij.org/blog/?p=1788|title=Breast or bottle: The final showdown|date=June 20, 2007|website=pcij.org|access-date=April 3, 2018|archive-date=July 29, 2010|archive-url=https://web.archive.org/web/20100729035119/http://www.pcij.org/blog/?p=1788|url-status=dead}}</ref>
 
''[[The Guardian]]'' newspaper reports widespread illegal advertising and marketing of formula milk contrary to [[World Health Organization]] guidelines. Doctors and midwives are encouraged to promote feeding babies formula milk, advertising also targets mothers directly. Babies get sick and sometimes die because poor mothers cannot sterilize bottles.<ref>[https://www.theguardian.com/lifeandstyle/2018/feb/27/formula-milk-companies-target-poor-mothers-breastfeeding How formula milk firms target mothers who can least afford it] ''[[The Guardian]]''</ref>

==== South Africa ====
In South Africa, there is a move towards plain packaging of infant formula<ref>[https://blogs.sun.ac.za/iplaw/2013/12/03/formula-for-plain-bland-packaging/ Formula for Plain (Bland) Packaging] ''The Anton Mostert Chair of Intellectual Property'', December 3, 2013. Retrieved 24 July, 2014</ref> under R 991 of the Foodstuffs, Cosmetics and Disinfectants Act; as of 6 December 2013, Regulation 7 (Sale and Promotion) is force, whereas Regulations 2-6 (primarily with respect to labelling) are scheduled to come into force on 6 December 2014.
One of the key requirements as per Regulation 3.1.A.iii is a conspicuous message stating “[t]his product shall only be used on the advice of a health professional”.

==== Thailand ====
In 2017, Thailand banned advertising for infant formula. Initially a ban on advertising for toddler formula was also proposed, but was dropped after the intervention of United States trade officials.<ref>{{Cite web |last=Tri-yasakda |first=Heather Vogell,June Watsamon |date=2024-03-21 |title=The U.S. Government Defended the Overseas Business Interests of Baby Formula Makers. Kids Paid the Price. |url=https://www.propublica.org/article/how-america-waged-global-campaign-against-baby-formula-regulation-thailand |access-date=2024-04-07 |website=ProPublica |language=en}}</ref>

==== United Kingdom ====
In the United Kingdom, infant formula advertising has been allowed since 1995;<ref>{{cite web|url=https://www.opsi.gov.uk/si/si1995/Uksi_19950077_en_1.htm|title=The Infant Formula and Follow–on Formula Regulations 1995|website=www.opsi.gov.uk|access-date=April 3, 2018}}</ref> advertising for "follow-on formula" is legal, which has been cited as a loophole allowing advertising of similarly packaged formula.<ref name="loophole">{{cite web|url=http://www.babyfriendly.org.uk/items/item_detail.asp?item=47|title=The Unicef UK Baby Friendly Initiative|website=Baby Friendly Initiative|access-date=April 3, 2018}}</ref>

==== United States ====

In the United States, infant formula is both heavily marketed—the country has not adopted [[International Code of Marketing of Breast-milk Substitutes|the Code]], nor is it being systematically implemented by manufacturers for domestic marketing<ref>[http://www.breastfeedingbasics.org/cgi-bin/deliver.cgi/content/International/his_code.html Breastfeeding Around the World: The International Code of Marketing of Breast Milk Substitutes.] {{webarchive|url=https://web.archive.org/web/20110503210250/http://breastfeedingbasics.org/cgi-bin/deliver.cgi/content/International/his_code.html |date=May 3, 2011 }} Retrieved August 9, 2011.</ref>—and even heavily [[subsidy|subsidized]] by the government: at least one third of the American market is supported by the government,<ref name="kaminis"/> with over half of infant formula sold in the country provided through the [[Special Supplemental Nutrition Program for Women, Infants, and Children]] (known as [[WIC program|WIC]]).<ref name="whopays">[http://www.ers.usda.gov/AmberWaves/September04/Features/infantformula.htm Sharing the Economic Burden: Who Pays for WIC’s Infant Formula?] {{webarchive|url=https://web.archive.org/web/20090511224550/http://ers.usda.gov/AmberWaves/September04/Features/infantformula.htm |date=May 11, 2009 }}, ''AmberWaves'', September 2004.</ref>

According to surveys, over 70% of large U.S. hospitals dispense infant formula to all infants, a practice opposed by the [[American Academy of Pediatrics]] and in violation of the Code.<ref name="AAPad">[http://www.aap.org/research/periodicsurvey/ps13.htm Periodic Survey of Fellows: Survey shows most AAP members support formula advertising policy] {{webarchive|url=https://web.archive.org/web/20110321185321/http://www.aap.org/research/periodicsurvey/ps13.htm |date=March 21, 2011 }}, American Academy of Pediatrics (AAP).</ref> The [[Gerber Products Company]] began marketing its brand of infant formula directly to the public in October 1989, while the [[Carnation Company]] began marketing ''Good Start'' infant formula directly to the public in January 1991.<ref name="AAPad" />

Infant formula costs are a significant fraction of the WIC program costs: 21% post-rebate and 46% pre-rebate.<ref name="whopays"/> Formula manufacturers are granted a WIC monopoly in individual states.<ref name="whopays"/> Meanwhile, breastfeeding rates are substantially lower for WIC recipients;<ref name="gao">[http://www.gao.gov/htext/d06282.html Breastfeeding: Some Strategies Used to Market Infant Formula May Discourage Breastfeeding; State Contracts Should Better Protect against Misuse of WIC Name] {{Webarchive|url=https://web.archive.org/web/20160303183249/http://www.gao.gov/htext/d06282.html |date=March 3, 2016 }}, U.S. Government Accountability Office (GAO)</ref> this is partly attributed to formula being free of charge to mothers in the WIC program, who are of lower socio-economic status.<ref name="whopays"/> Violations of federal policy have also been found in terms of infant formula company advertising using the WIC trademark, to reach both WIC and non-WIC participants.<ref name="gao"/> In recent years WIC has been expanding its [[breastfeeding promotion]] strategies, including providing subsidies for clients who use [[milk bank]]s.<ref>[http://www.breastfeeding.com/all_about/all_about_milk_banks.html Banking on Breastmilk] {{webarchive|url=https://web.archive.org/web/20090531022711/http://www.breastfeeding.com/all_about/all_about_milk_banks.html |date=May 31, 2009 }}</ref>

=== 2022 United States Baby Formula Shortages ===

[[2021–2022 global supply chain crisis|Supply chain disruptions]] related to the government response to the [[COVID-19 pandemic in the United States]] have been reported<ref name="US 2022 infant formula shortage – Reason" /> as responsible for causing widespread [[2022 United States infant formula shortage|shortages of infant formula]] in the United States, as of May 2022. This contrasts with far less severe shortages of infant formula around the globe. [[Reason (magazine)|Reason magazine]] reported that this was largely the result of [[Food and Drug Administration]] (FDA) processes delaying approval of otherwise safe infant formula from Europe or other sources abroad, which might otherwise have eased demand for infant formula tensions in the United States.<ref name="US 2022 infant formula shortage – Reason">{{cite web |last1=Soave |first1=Robby |title=The U.S. Baby Formula Shortage Is the FDA's Fault |url=https://reason.com/2022/05/10/baby-formula-shortage-fda-approval-biden/ |website=reason.com |date=May 10, 2022 |publisher=Reason |access-date=13 May 2022}}</ref>

As a result of the shortages, on May 16, 2022, the FDA announced that it would temporarily ease enforcement of some labeling rules to allow the importation of foreign formulas. FDA Commissioner [[Robert Califf]] stated, "Today's action paves the way for companies who don't normally distribute their infant formula products in the U.S. to do so efficiently and safely. We anticipate that those products that can quickly meet safety and nutrition standards could hit U.S. stores in a matter of weeks."<ref>{{cite web|url=https://www.fda.gov/news-events/press-announcements/fda-encourages-importation-safe-infant-formula-and-other-flexibilities-further-increase-availability|archive-url=https://web.archive.org/web/20220516223533/https://www.fda.gov/news-events/press-announcements/fda-encourages-importation-safe-infant-formula-and-other-flexibilities-further-increase-availability|url-status=dead|archive-date=May 16, 2022|title=FDA Encourages Importation of Safe Infant Formula and Other Flexibilities to Further Increase Availability |website=[[Food and Drug Administration]] |date=May 16, 2022}}</ref> Former FDA associate commissioner, Peter Pitts, asserts that the FDA's regulatory scheme is at least partially to blame for the shortage. Pitts states, "The difference between European baby formula and American baby formula, more or less, is that the labeling is different. The knot in getting that product into the U.S. isn't safety, it's a regulatory issue. I don't want to say it's a nitty issue, but it's certainly something the FDA could have jumped on a lot quicker."<ref>{{cite web|url=https://reason.com/2022/05/17/fda-baby-formula-peter-pitts-safety-european-shortage/|title=Former FDA Official: The Prohibition on European Baby Formula Isn't About Safety | date=May 17, 2022}}</ref>

Amid and prior to the formula shortages, Woman and Infant Children (WIC) centers in Georgia and North Carolina were disposing of infant formula.<ref>{{cite news|url=https://www.ajc.com/news/georgia-news/georgia-destroys-thousands-of-dollars-worth-of-baby-formula-every-year-heres-why/NJWSS6MYCNE57GVXINABGAK4MU/|title=Georgia destroys thousands of cans of baby formula every year. Here's why. |newspaper=The Atlanta Journal-Constitution |date=May 22, 2022|last1=Grinspan |first1=Lautaro }}</ref><ref>{{cite web|url=https://www.wral.com/investigation-finds-nc-destroying-infant-formula-supplies-despite-shortages/20312111/|title=WRAL INVESTIGATES Investigation finds NC destroying infant formula supplies despite shortages |date=June 2, 2022}}</ref>   This was done under the USDA's recommendation that unused, returned WIC infant formula were to be disposed of upon return.<ref>{{cite web|url=https://fnsprod.azureedge.us/sites/default/files/resource-files/WPM-2020-1-DonationofUnsedReturnedInfantFormula.pdf |title=WIC Policy Memo 2020-1: Donation of Unsed Returned Infant Formula |date=December 12, 2019}}{{Dead link|date=February 2023}}</ref> Despite an attempt by the USDA to walk back this recommendation by stating that it is a recommendation rather than a requirement, the USDA confirms that it will not reverse this recommendation, even amid the formula shortage.<ref>{{cite web|url=https://reason.com/2022/06/08/following-usda-guidance-state-clinics-destroyed-thousands-of-cans-of-usable-baby-formula/ |title=Following USDA Guidance, State Clinics Destroyed Thousands of Cans of Usable Baby Formula |date=June 8, 2022}}</ref> As a result, from October 2021 through May 2022, 16,459 cans of baby formula were destroyed by WIC clinics in Georgia and an unknown amount of baby formula cans were destroyed in North Carolina and other US States.

On July 6, 2022, the FDA announced that it would change its rules to allow foreign formula manufacturers to permanently import their goods into the U.S., potentially reducing the severity of the shortage.<ref>{{cite web|url=https://www.fda.gov/news-events/press-announcements/fda-developing-new-framework-continued-expanded-access-infant-formula-options-us-parents-and|archive-url=https://web.archive.org/web/20220706185158/https://www.fda.gov/news-events/press-announcements/fda-developing-new-framework-continued-expanded-access-infant-formula-options-us-parents-and|url-status=dead|archive-date=July 6, 2022|title=FDA Developing New Framework for Continued, Expanded Access to Infant Formula Options for U.S. Parents and Caregivers|website=[[Food and Drug Administration]] |date=July 6, 2022}}</ref> Critics of the FDA note that this does not remove the regulations entirely and that this shortage has been self-imposed by the FDA from the start.<ref>{{cite web|url=https://reason.com/2022/07/07/fda-finally-admits-it-caused-the-baby-formula-shortage/|title=FDA Finally Admits It Caused the Baby Formula Shortage|date=July 7, 2022}}</ref> Additionally, critics note that if a formula maker passes EU regulations, this should be good enough for the FDA to allow importation of that formula.

Critics of the FDA's regulatory policy note that the regulatory scheme surrounding European formulas is not borne from a science-based desire to protect children, but rather an influence that the US dairy industry has on the agency.<ref>{{cite web|url=https://www.usdec.org/Documents/TPA-105-003_Public%20Comments_NMPF%20USDEC%20ITC%20USMCA%20Submission.12.20.18.pdf|title=Submission by the U.S. Dairy Export Council and the National Milk Producers FederationRegarding United States-Mexico-Canada Agreement: Likely Impact on the U.S. Economy andon Specific Industry Sectors (Investigation No. TPA-105-003)|date=December 20, 2018|access-date=October 13, 2022|archive-date=April 19, 2022|archive-url=https://web.archive.org/web/20220419140913/https://www.usdec.org/Documents/TPA-105-003_Public%20Comments_NMPF%20USDEC%20ITC%20USMCA%20Submission.12.20.18.pdf|url-status=dead}}</ref><ref name="reason.com">{{cite web|url=https://reason.com/2022/07/25/my-baby-needed-special-formula-from-europe-u-s-trade-policy-made-it-almost-unobtainable/|title=My Baby Needed Special Formula From Europe. U.S. Trade Policy Made It Almost Unobtainable.|date=July 25, 2022}}</ref>  Critics also note that if there were an issue with European formulas, the issue would be widespread among the European babies that regularly consume the formula.<ref>{{cite web|url=https://www.nytimes.com/wirecutter/blog/us-parents-european-baby-formula/|title=Why US Parents Are Choosing European Baby Formula|website=[[The New York Times]] |date=March 12, 2021}}</ref><ref name="reason.com"/>

The FORMULA Act is set to expire at the end of 2022, which will subsequently reinstate tariffs on foreign made formula.<ref>{{cite web|url=https://www.congress.gov/bill/117th-congress/house-bill/8351|title=H.R.8351 - Formula Act|date=July 13, 2022}}</ref>  Experts worry that this will result in a repeat formula shortage for 2023.<ref>{{cite web|url=https://reason.com/2022/12/13/the-government-hasnt-learned-a-thing-from-the-baby-formula-shortage/|title=The Government Hasn't Learned a Thing From the Baby Formula Shortage|date=December 13, 2022}}</ref> The CEO of the National Milk Producers Federation, a lobbying organization for dairy producers, wrote in a letter to Congress and the Biden administration to allow for the reinstatement of tariffs on foreign baby formula to commence.<ref>{{cite web|url=https://www.nmpf.org/wp-content/uploads/2022/11/NMPF-Letter-to-Congress-on-Restoration-of-US-Formula-Tariffs_Nov-17-2022.pdf|title=National Milk Producers Federation Letter to Congress|date=November 17, 2022}}</ref>

==History==
The [[Wabanaki Confederacy|Wabanaki]] and other Native American tribal nations of North America made an infant formula from nuts and cornmeal.<ref>{{Cite web| vauthors = Kamila AY |date=2020-11-08|title=Americans have been enjoying nut milk and nut butter for at least 4 centuries|url=https://www.pressherald.com/2020/11/08/vegan-kitchen-americans-have-been-enjoying-nut-milk-and-nut-butter-for-at-least-4-centuries/|access-date=2021-01-06|website=Portland Press Herald}}</ref> [[Elizabeth Hanson (captive of Native Americans)|Elizabeth Hanson]] was kidnapped by Wabanaki in 1725 and a Native American woman showed Hanson how to make this infant formula and she included this in her captivity narrative.

===Early infant foods===
In 1865, the first infant food was invented {{where|date=December 2023}} .<ref>{{cite journal | vauthors = Stevens EE, Patrick TE, Pickler R | title = A history of infant feeding | journal = The Journal of Perinatal Education | volume = 18 | issue = 2 | pages = 32–39 | year = 2009 | pmid = 20190854 | pmc = 2684040 | doi = 10.1624/105812409X426314 }}</ref>
Throughout history, mothers who could not breastfeed their babies either employed a [[wet nurse]]<ref name="Schuman">{{cite web | author = Schuman A | title = A concise history of infant formula (twists and turns included) | publisher = Contemporary Pediatric | date = February 1, 2003 | url = http://www.contemporarypediatrics.com/contpeds/article/articleDetail.jsp?id=111702 | access-date = September 16, 2006 | journal =  | archive-date = August 23, 2006 | archive-url = https://web.archive.org/web/20060823074531/http://www.contemporarypediatrics.com/contpeds/article/articleDetail.jsp?id=111702 | url-status = dead }}</ref> or, less frequently, prepared food for their babies, a process known as "dry nursing".<ref name = "Schuman"/><ref name="food-timeline">{{cite web |work=[[The Food Timeline]] | vauthors= Olver L |author-link=Lynne Olver |title=Food Timeline – history notes: baby food |year=2004 |url=http://www.foodtimeline.org/foodbaby.html |access-date=September 16, 2006}}</ref> Baby food composition varied according to region and economic status.<ref name="food-timeline"/> In Europe and North America during the early 19th century, the prevalence of wet nursing began to decrease, while the practice of feeding babies mixtures based on animal milk rose in popularity.<ref name="Spaulding">{{cite book | vauthors = Spaulding M, Welch P | title = Nurturing Yesterday's Child: A Portrayal of the Drake Collection of Paediatric History | publisher = B C Decker Inc | year = 1994 | isbn=978-0-920474-91-4 }}</ref><ref name="Hale">{{cite book | vauthors = Hale SJ | author-link = Sarah Josepha Hale | title = The Ladies' New Book of Cookery: A Practical System for Private Families in Town and Country | publisher = H. Long & Brother | year = 1852 | location = New York | pages = 437 | url = https://digital.lib.msu.edu/projects/cookbooks/html/books/book_19.cfm }}</ref> <!-- FAIR USE of Nestle-milk-poster.jpg: see image description page at http://en.wikipedia.org/wiki/File:Nestle-milk-poster.jpg for rationale --> [[File:Nestle-milk-poster.jpg|left|200px|thumb|Poster advertisement for Nestle's Milk by Théophile Alexandre Steinlen, 1895]] This trend was driven by cultural changes as well as increased sanitation measures,<ref name="IOM FNB">{{cite book | vauthors=((Institute of Medicine)), ((Food and Nutrition Board)), ((Committee on the Evaluation of the Addition of Ingredients New to Infant Formula)) | title=Infant Formula: Evaluating the Safety of New Ingredients | publisher=National Academies Press | year=2004 | isbn=978-0-309-18550-9 | url=https://books.google.com/books?id=aBLX_59za9sC | access-date=2022-05-16}}</ref> and it continued throughout the 19th and much of the 20th century, with a notable increase after [[Elijah Pratt]] invented and patented the [[Baby bottle#History|India-rubber nipple]] in 1845.<ref name = "Schuman"/><ref name="bottle museum">{{cite web|title=The history of the feeding bottle |url=http://www.babybottle-museum.co.uk/teats%20through%20the%20ages.htm |access-date=September 16, 2006 |archive-url=https://web.archive.org/web/20060830112545/http://www.babybottle-museum.co.uk/teats%20through%20the%20ages.htm |archive-date=August 30, 2006 |url-status=dead |df=mdy-all }}</ref> As early as 1846, scientists and nutritionists noted an increase in medical problems and infant mortality was associated with dry nursing.<ref name="Spaulding"/><ref name="simon">{{cite book | vauthors = Simon JF | title = Animal chemistry: with reference to the physiology and pathology of man | publisher = Lea and Blanchard | year = 1846 | oclc = 5884760 }}</ref> In an attempt to improve the quality of manufactured baby foods, in 1867, [[Justus von Liebig]] developed the world's first commercial infant formula, ''Liebig's Soluble Food for Babies''.<ref name="Levenstein">{{cite book | vauthors = Levenstein H | title = Revolution at the Table: The Transformation of the American Diet | url = https://archive.org/details/revolutionattabl00leve | url-access = registration | publisher = Oxford University Press | year = 1988 | location = New York | page=[https://archive.org/details/revolutionattabl00leve/page/122 122] | isbn=978-0-520-23439-0 }}</ref> The success of this product quickly gave rise to competitors such as [[Mellin's Food]], Ridge's Food for Infants and [[Nestlé]]'s Milk.<ref name="levenstein2">{{cite journal | vauthors = Levenstein H | title = "Best for babies" or "preventable infanticide"? The controversy over artificial feeding of infants in America, 1880-1920 | journal = Journal of American History | volume = 70 | issue = 1 | pages = 75–94 | date = June 1983 | pmid = 11617247 | doi = 10.2307/1890522 | jstor = 1890522 }}</ref>{{clear left}}

===Raw milk formulas===
As physicians became increasingly concerned about the quality of such foods, medical recommendations such as [[Thomas Morgan Rotch]]'s "percentage method" (published in 1890) began to be distributed, and gained widespread popularity by 1907.<ref name = "Schuman"/> These complex formulas recommended that parents mix cow's milk, water, cream, and sugar or honey in specific ratios to achieve the nutritional balance believed to approximate human milk reformulated in such a way as to accommodate the believed digestive capability of the infant.<ref name="Fomon"/>

[[File:Nestlé Food advertisement, 1915.jpg|thumb|A 1915 advertisement for "Nestlé's Food"]]
At the dawn of the 20th century in the United States, most infants were breastfed, although many received some formula feeding as well. Home-made "percentage method" formulas were more commonly used than commercial formulas in both Europe and the United States.<ref name="friedenwald">{{cite book | vauthors = Friedenwald J, Ruhrah J | title = Diet in Health and Disease | publisher = W.B. Saunders Co. | year = 1910 | location = New York | url = https://hearth.library.cornell.edu/cgi/t/text/text-idx?c=hearth;idno=4388698 }}</ref> They were less expensive and were widely believed to be healthier. However, formula-fed babies exhibited more diet-associated medical problems, such as [[scurvy]], [[rickets]] and bacterial infections than breastfed babies. By 1920, the incidence of scurvy and rickets in formula-fed babies had greatly decreased through the addition of [[orange juice]] and [[cod liver oil]] to home-made formulas. Bacterial infections associated with formula remained a problem more prevalent in the United States than in Europe, where milk was usually boiled prior to use in formulas.<ref name="friedenwald"/>

===Evaporated milk formulas===
In the 1920s and 1930s, [[evaporated milk]] began to be widely commercially available at low prices, and several clinical studies in the period suggested that breastfed babies and babies fed evaporated milk equally thrived.<ref name = "Schuman"/><ref name="Marriott">{{cite journal | vauthors = Marriott WM, Schoenthal L | title = An experimental study of the use of unsweetened evaporated milk for the preparation of infant feeding formulas | journal = Archives of Pediatrics | volume = 46 | pages = 135–148 | year = 1929 }}</ref>

These studies, accompanied by the affordable price of [[evaporated milk]] and the availability of the home icebox initiated a tremendous rise in the use of evaporated milk formulas.<ref name = "Fomon"/> By the late 1930s, the use of evaporated milk formulas in the United States surpassed all commercial formulas, and by 1950 over half of all babies in the United States were reared on such formulas.<ref name="Schuman"/>

===Commercial formulas===
In parallel with the enormous shift (in industrialized nations) away from breastfeeding to home-made formulas, nutrition scientists continued to analyze human milk and attempted to make infant formulas that more closely matched its composition.<ref name="Fomon" /> [[Maltose]] and [[dextrin]]s were believed nutritionally important, and in 1912, the [[Mead Johnson]] Company released a milk additive called ''Dextri-Maltose''. This formula was made available to mothers only by physicians. In 1919, milkfats were replaced with a blend of animal and vegetable fats as part of the continued drive to closer simulate human milk. This formula was called SMA for "simulated milk adapted."<ref name="Schuman" />

In the late 1920s, [[Alfred Bosworth (inventor)|Alfred Bosworth]] released ''[[Similac]]'' (for "similar to lactation"), and Mead Johnson released ''Sobee''.<ref name="Schuman" /> Several other formulas were released over the next few decades, but commercial formulas did not begin to seriously compete with evaporated milk formulas until the 1950s. The reformulation and concentration of Similac in 1951, and the introduction (by Mead Johnson) of Enfamil (for "infant milk") in 1959 were accompanied by marketing campaigns that provided inexpensive formula to hospitals and pediatricians.<ref name="Schuman" /> By the early 1960s, commercial formulas were more commonly used than evaporated milk formulas in the United States, which all but vanished in the 1970s. By the early 1970s, over 75% of American babies were fed on formulas, almost entirely commercially produced.<ref name="Fomon" />

When birth rates in industrial nations tapered off during the 1960s, infant formula companies heightened marketing campaigns in non-industrialized countries. The poor sanitation in these countries led to steeply increased [[infant mortality|mortality rates]] among infants fed the often contaminated formula.<ref name = "Solomon">{{cite news| vauthors = Solomon S | title = The Controversy Over Infant Formula | work = The New York Times | pages = 8 | url = https://query.nytimes.com/gst/fullpage.html?res=9D06E2D61738F935A35751C1A967948260&sec=health&spon=&pagewanted=5| access-date =August 11, 2008 | date=December 6, 1981}}</ref> Additionally, a WHO has cited over-diluting formula preparations as resulting in infant malnourishment.<ref>[https://web.archive.org/web/20130806074415/http://www.who.int/mediacentre/news/releases/2013/world_breastfeeding_week_20130730/en/ Breastfeeding: Only 1 in 5 countries fully implement WHO’s infant formula Code], WHO, 30 July 2013.</ref> Organized protests, the most famous of which was the [[Nestlé boycott]] of 1977, called for an end to unethical marketing. This boycott is ongoing, as the current coordinators maintain that Nestlé engages in marketing practices which violate the [[International Code of Marketing of Breast-milk Substitutes]].

===Generic brand formulas===
In addition to commercially marketed brands, [[generic brand]]s (or store brands) of infant formula were introduced in the United States in 1997, first by PBM Products. These [[private label]] formulas are sold by many leading food and drug retailers such as [[Wal-Mart]], [[Target Corporation|Target]], [[Kroger]], [[Loblaws]], and [[Walgreens]]. All infant formula brands in the United States are required to adhere to the [[Food and Drug Administration]] (FDA) guidelines. As reported by the [[Mayo Clinic]]: “as with most consumer products, brand-name infant formulas cost more than generic brands. But that doesn't mean that brand-name [Similac, Nestle, Enfamil] formulas are better. Although manufacturers may vary somewhat in their formula recipes, the FDA requires that all formulas contain the same nutrient density.”<ref>[http://www.mayoclinic.com/health/infant-formula/PR00058 Mayo Clinic], November 2007</ref>

Similarly, in Canada all infant formulas regardless of brand are required to meet standards set by Health Canada.<ref>Government of Alberta, Health and Wellness. [http://www.health.alberta.ca/health-info/baby-formula.html Infant formula.] {{webarchive|url=https://web.archive.org/web/20111007111614/http://www.health.alberta.ca/health-info/baby-formula.html |date=October 7, 2011 }}</ref>

===Follow-on, transition, and toddler formulas===
Follow-on or toddler formulas are sold for ages 6 months to 3 years (when infants are typically breastfed). In the US, a '''transition formula''' is marketed for children from age 9 to 24 months, and a '''toddler milk''' is sold for children age 12 to 26 months.<ref name=":0">{{cite journal | vauthors = Pomeranz JL, Romo Palafox MJ, Harris JL | title = Toddler drinks, formulas, and milks: Labeling practices and policy implications | journal = Preventive Medicine | volume = 109 | pages = 11–16 | date = April 2018 | pmid = 29339115 | doi = 10.1016/j.ypmed.2018.01.009 | s2cid = 205851897 }}</ref> In the UK, '''follow-on milk''' is marketed towards children 6-12 months, and toddler milk for children aged 2 to 3 years. Toddler milk marketed in the US contains [[powdered milk]], [[corn syrup]] and other [[added sugar]]s, [[vegetable oil]], and [[salt]].<ref name=":1">{{Cite news|url=https://www.npr.org/sections/thesalt/2018/02/20/585875339/toddler-milks-filling-a-nutritional-need-or-a-marketing-niche|title=Toddler Milks: Filling A Nutritional Need Or A Marketing Niche?|publisher=[[NPR]]|language=en|access-date=2020-02-26}}</ref><ref name=":2">{{Cite web|url=https://www.theatlantic.com/health/archive/2020/02/should-you-buy-toddler-milk/606028/|title=The Ominous Rise of Toddler Milk| vauthors = Khazan O |date=2020-02-04|website=The Atlantic|language=en-US|access-date=2020-02-26}}</ref>

Toddler formulas are not nutritionally complete, nor are they subject to the same regulations or [[List of food labeling regulations|food labeling laws]] as infant formula.<ref name=":0" /> Critics have argued that follow-on and toddler formulas were introduced to circumvent the regulations regarding infant formula and have resulted in confusing advertising.<ref name="loophole" />

An early example of follow-on formula was introduced by [[Wyeth]] in the Philippines in 1987, following the introduction in this country of regulations on infant formula advertising, but which did not address follow-on formulas (products that did not exist at the time of their drafting).<ref name="milkcode" /> Similarly, while infant formula advertising is illegal in the United Kingdom, follow-on formula advertising is legal, and the similar packaging and market results in follow-on advertisements frequently being interpreted as advertisements for formula.<ref name="loophole"/> (See also [[#Policy, industry and marketing|industry and marketing]], below.)

These products have also recently fallen under criticism for contributing to the [[childhood obesity]] epidemic in some developed countries due to their marketing and flavoring practices.<ref>ABC News. [https://abcnews.go.com/Health/Diabetes/mead-johnson-drops-chocolate-flavored-emfagrow-parent-uproar/story?id=10876301 Chocolate Toddler 'Formula' Pulled After Sugar Uproar.] June 10, 2010.</ref> The drinks are also expensive.<ref name=":2" /> Although usually not quite as expensive as infant formula,<ref name=":1" /> they can cost four times the price of cow's milk.<ref name=":2" />

===Usage since 1970s===
Since the early 1970s, industrial countries have witnessed a resurgence in [[breastfeeding]] among newborns and infants to 6 months of age.<ref name="Ryan"/> This upswing in breastfeeding has been accompanied by a deferment in the average age of introduction of other foods (such as cow's milk), resulting in increased use of both breastfeeding and infant formula between the ages of 3–12 months.<ref name="Fomon"/><ref name="Ryan"/>

The global infant formula market has been estimated at $7.9 billion,<ref name="kaminis">[https://web.archive.org/web/20050211092050/http://businessweek.com/investor/content/jan2005/pi20050111_1011_pi008.htm A Growing Boost for Baby Formula], by Markos Kaminis, BusinessWeek, January 11, 2005</ref> with North America and Western Europe accounting for 33% of the market and considered largely saturated, and Asia representing 53% of the market.<ref name="ubic"/> South East Asia is a particularly large fraction of the world market relative to its population.<ref name="ubic"/> Infant formula is the largest segment of the baby food market,<ref name="ubic">[http://www.ubic-consulting.com/food/ingredient/chemical-industries/ingredients-worl-infant-formula-market.html Ingredients for the World Infant Formula Market] {{Webarchive|url=https://web.archive.org/web/20150907044946/http://www.ubic-consulting.com/food/ingredient/chemical-industries/ingredients-worl-infant-formula-market.html |date=September 7, 2015 }}, UBIC consulting</ref><!--<ref name="agc">{{cite web|url=http://answers.google.com/answers/threadview?id=423654|title=Google Answers: Infant Formula Sales/Market/Statistics|website=answers.google.com|access-date=April 3, 2018}}</ref>--> with the fraction given as between 40%<ref name="ubic"/> and 70%.<ref name="kaminis" /><!--<ref name="agc"/>-->

Leading health organizations (e.g. [[World Health Organization|WHO]], U.S. [[Centers for Disease Control]] and [[United States Department of Health and Human Services|Department of Health and Human Services]]) are attempting to reduce the use of infant formula and increase the prevalence of breastfeeding from birth through 12 to 24 months of age through [[public health]] awareness campaigns.<ref name="CDC Breastfeeding FAQ">{{cite web | title = Breastfeeding Frequently Asked Questions | publisher = Centers for Disease Control and Prevention | url =https://www.cdc.gov/breastfeeding/faq/index.htm | date = May 22, 2007 | access-date =May 24, 2008}}</ref><ref name="CDC Promotion">{{cite web | title = Promotion & Support of Breastfeeding and Obesity Prevention | publisher = Centers for Disease Control and Prevention | date = May 22, 2007 | url = https://www.cdc.gov/breastfeeding/promotion/index.htm | access-date =May 24, 2008}}</ref><ref name="HHS Promotion">{{cite press release | title = Public Service Campaign to Promote Breastfeeding Awareness Launched | publisher = United States Department of Health and Human Services | date = June 4, 2006 | url = https://www.hhs.gov/news/press/2004pres/20040604.html | access-date = May 22, 2008 | archive-date = April 28, 2008 | archive-url = https://web.archive.org/web/20080428015415/http://www.hhs.gov/news/press/2004pres/20040604.html | url-status = dead }}</ref><ref name="WHO Promotion">{{cite web | title = Promoting proper feeding for infants and young children | publisher = World Health Organization | url =https://www.who.int/nutrition/topics/infantfeeding/en/index.html | archive-url =https://web.archive.org/web/20060322073228/http://www.who.int/nutrition/topics/infantfeeding/en/index.html | url-status =dead | archive-date =March 22, 2006 | access-date =May 24, 2008}}</ref> The specific goals and approaches of these [[breastfeeding promotion]] programs, and the policy environment surrounding their implementation, vary by country. As a policy basic framework, the [[International Code of Marketing of Breast-milk Substitutes]], adopted by the WHO's [[World Health Assembly]] in 1981, requires infant formula companies to preface their product information with statements that breastfeeding is the best way of feeding babies and that a substitute should only be used after consultation with health professionals.<ref name="ICMBS">{{cite book | title = International Code of Marketing of Breast-Milk Substitutes | publisher = World Health Organization | year = 1981 | url =https://www.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=15&codcch=94 | archive-url =https://web.archive.org/web/20031225204504/http://www.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=15&codcch=94 | url-status =dead | archive-date =December 25, 2003 | isbn = 978-92-4-154160-2 }}</ref> The [[Baby Friendly Hospital Initiative]] (BFHI) also restricts use by hospitals of free formula or other infant care aids provided by formula companies. (See also [[#Policy, industry and marketing|Policy]] section below.) While the Code was intended to restrict inappropriate ''marketing'' of infant formula, not access to it, parents have complained of being lectured or made to sign waivers implying formula would harm their babies in BFHI hospitals.<ref>{{Cite web |title=My "Baby Friendly" Hospital Harmed My Baby: How Hospitals Can Do Better {{!}} National Women's Health Network |url=https://nwhn.org/my-baby-friendly-hospital-harmed-my-baby-and-how-hospitals-can-do-better/ |access-date=2022-03-12 |language=en-US |archive-date=April 7, 2022 |archive-url=https://web.archive.org/web/20220407082210/https://nwhn.org/my-baby-friendly-hospital-harmed-my-baby-and-how-hospitals-can-do-better/ |url-status=dead }}</ref>

==Infant formula processing==

=== History ===
{| class="wikitable"
|-
! Dates !! Events
|- style="background:white"
| ''' 1867 '''
| A formula containing wheat flour, cow's milk, malt flour, and potassium bicarbonate was developed.<ref name=name>Institute of Medicine (U.S.) (2004). Defining Safety for Infants. In [http://books.nap.edu/openbook.php?isbn=0309091500&page=42# “Infant Formula: Evaluating the Safety of New Ingredients”], The National Academic Press. pp.&nbsp;22–42., Retrieved on November 15, 2009.</ref>
|- style="background:white"
| ''' 1915 '''
| A powder form of infant formula was introduced, containing cow's milk, lactose, oleo oils, and vegetable oils.<ref name=name />
|- style="background:white"
| ''' 1929 '''
| Soy formula was introduced.<ref name=name />
|- style="background:white"
| ''' 1935 '''
| Protein was added because it was believed cow's milk protein content was lower than human milk protein content; protein at 3.3–4.0 g/100 kcal was added.<ref name=name />
|- style="background:white"
| ''' 1959 '''
| Iron fortification was introduced because a large amount of iron (~80%) is used to expand the red blood cell mass in a growing infant. Infants with birth weights between 1500 and 2500g require 2&nbsp;mg/kg of iron per day. Infants with weights of less than 1500g require 4&nbsp;mg/kg per day.<ref name=name /><ref>{{cite journal | vauthors = American | year = 1999 | title = Iron fortification of infant formulas | journal = Pediatrics | volume = 104 | issue = 1| pages = 119–123 | doi=10.1542/peds.104.1.119| doi-access = free }}</ref>
|- style="background:white"
| ''' 1962 '''
| The [[whey]]:[[casein]] ratio was made similar to human milk because producers were aware that human milk contains a higher ratio of whey protein, and cow's milk contains a higher ratio of casein.<ref name=name />
|- style="background:white"
| ''' 1984 '''
| [[Taurine]] fortification was introduced because newborn infants lack the enzymes needed to convert and form taurine.<ref name=name /><ref>{{cite journal | vauthors = Heird WC | title = Taurine in neonatal nutrition--revisited | journal = Archives of Disease in Childhood. Fetal and Neonatal Edition | volume = 89 | issue = 6 | pages = F473–F474 | date = November 2004 | pmid = 15499132 | pmc = 1721777 | doi = 10.1136/adc.2004.055095 }}</ref>
|- style="background:white"
| ''' Late 1990 '''
| Nucleotide fortification was introduced into infant formula because nucleotides can act as growth factors and may enhance the infant immune system.<ref name=name />
|- style="background:white"
| ''' Early 2000 '''
| Polyunsaturated fatty acid fortification was introduced. Polyunsaturated fatty acids, such as [[docosahexaenoic acid]] (DHA) and [[arachidonic acid]] (ARA), were added because those fatty acids play an important role in infant brain development.<ref name=name />
|}

=== Current general procedure ===
The manufacturing process may differ for different types of formula made; therefore the following is the general procedure for liquid-milk based formulas:<ref name="two" />

==== Mixing ingredients ====
Primary ingredients are blended in large stainless steel tanks and skim milk is added and adjusted to 60&nbsp;°C. Then, fats, oils and emulsifiers are added. Additional heating and mixing may be required to get proper consistency. Next, minerals, vitamins, and stabilizing gums are added at various points, depending on their sensitivity to heat. The batch is temporarily stored and then transported by pipelines to pasteurization equipment when mixing is complete.<ref name="two" />

==== Pasteurization ====
This is a process that protects against spoilage by eliminating bacteria, yeasts and molds.
It involves quickly heating and then cooling of the product under controlled conditions which micro-organisms cannot survive. The batch is held at around 85–94&nbsp;°C for approximately 30 seconds which is necessary to adequately reduce micro-organisms and prepare the formula for filling.<ref name="two" />

==== Homogenization ====
This is a process which increases emulsion uniformity and stability by reducing size of fat and oil particles in the formula. It is done with a variety of mixing equipment that applies shear to the product and this mixing breaks fat and oil particles into very small droplets.<ref name="two" />

==== Standardization ====
Standardization is used to ensure that the key parameters like pH, fat concentration and vitamins and mineral content are correct. If insufficient levels of these are found, the batch is reworked to achieve appropriate levels. After this step, the batch is ready to be packaged.<ref name="two" />

==== Packaging ====
Packaging depends on manufacturer and type of equipment used, but in general, liquid formula is filled into metal cans with lids crimped into place.<ref name="two" />

==== Heat treatment or sterilization ====
Finally, infant formulas are heat treated to maintain the bacteriologic quality of the product. This can be done traditionally by either retort sterilization or high-temperature short-time (HTST) treatment. Recently, ultrahigh-temperature treated formula has become more commonly used. If powdered formula is made, then [[spray drying]] would be required in addition.<ref name="multiple">{{cite journal | vauthors = Lönnerdal B, Hernell O | title = Effects of feeding ultrahigh-temperature (UHT)-treated infant formula with different protein concentrations or powdered formula, as compared with breast-feeding, on plasma amino acids, hematology, and trace element status | journal = The American Journal of Clinical Nutrition | volume = 68 | issue = 2 | pages = 350–356 | date = August 1998 | pmid = 9701193 | doi = 10.1093/ajcn/68.2.350 | doi-access = free }}</ref> Retort sterilization is a traditional retort sterilization method that uses 10-15mins treatment at 118&nbsp;°C.<ref name="multiple"/> Ultrahigh-temperature (UHT) is a method that uses a brief (2–3 seconds) treatment at 142&nbsp;°C. Because of the short time used, there is little protein denaturation, but the process still ensures sterility of the final product.<ref name="multiple"/>

=== Recent and future potential new ingredients ===

==== Probiotics ====
Randomized, controlled trials completed in the 2000s have shown limited and short term clinical benefits for the use of [[probiotics]] in infants' diet.<ref name="probiotics">Carvalho, R.S., Michail, S., Ashai-Khan, F., Mezoff, A.G. (2008). An Update on Pediatric Gastroenterology and Nutrition: A Review of Some Recent Advances. ''Curr Probl Pediatr Adolesc Health Care,'' 204–228.</ref> A 2018 clinical study using the multistrain [[De Simone Formulation]] probiotic showed it helped some infants reduce symptoms of infant colic.<ref>{{cite journal | pmc=5852771 | year=2018 | last1=Baldassarre | first1=M. E. | last2=Di Mauro | first2=A. | last3=Tafuri | first3=S. | last4=Rizzo | first4=V. | last5=Gallone | first5=M. S. | last6=Mastromarino | first6=P. | last7=Capobianco | first7=D. | last8=Laghi | first8=L. | last9=Zhu | first9=C. | last10=Capozza | first10=M. | last11=Laforgia | first11=N. | title=Effectiveness and Safety of a Probiotic-Mixture for the Treatment of Infantile Colic: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial with Fecal Real-Time PCR and NMR-Based Metabolomics Analysis | journal=Nutrients | volume=10 | issue=2 | page=195 | doi=10.3390/nu10020195 | pmid=29439395 | doi-access=free }}</ref>  The safety of probiotics in general and in infants, especially preterm infants, has been investigated in a limited number of controlled trials. The findings thus far suggest probiotics are generally safe, though the research is preliminary and has yet to provide definitive conclusions.<ref name="probiotics"/>

==== Prebiotics ====
[[Prebiotic (nutrition)|Prebiotics]] are undigestible carbohydrates that promote the growth of probiotic bacteria in the gut. Human milk contains a variety of oligosaccharides believed to be an important factor in the pattern of microflora colonization of breastfed infants. Because of variety, variability, complexity and polymorphism of the oligosaccharide composition and structure, it is currently not feasible to reproduce the oligosaccharide components of human milk in a strictly structural fashion.<ref name="prebiotic">International Assassination of Infant Food Manufacturers,[http://www.ifm.net/industry/prebiotics.htm “Prebiotics in Infant Nutrition”] {{webarchive|url=https://web.archive.org/web/20100107145212/http://www.ifm.net/industry/prebiotics.htm |date=January 7, 2010 }}, November 9, 2009</ref>

The European Society of Pediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition found evidence to support short term effects of ingesting prebiotics on stool microflora of infants with increased in the number of bifidobacteria. Babies can be at risk of dehydration with the induction of softer stools, if they have the kidney immaturity and/or a poor ability to concentrate urine.<ref name="prebiotic"/> A reduction of pathogens has been associated with the consumption of prebiotics.<ref name="prebiotic"/> However, there was no evidence to support major clinical or long-term benefits.<ref name="probiotics"/> Therefore, there is little evidence of beneficial effects of prebiotics in dietary products.<ref name="probiotics"/>

==== Lysozyme and lactoferrin ====
[[Lysozyme]] is an enzyme that is responsible for protecting the body by damaging bacterial cell walls. [[Lactoferrin]] is a globular, multifunctional protein that has antimicrobial activity. Compared to human milk, cow's milk has a signifactly lower levels of lysozyme and lactoferrin; therefore, the industry has an increasing interest in adding them into infant formulas.<ref name=name/>

====Long chain polyunsaturated fatty acid supplementation====
Some manufacturers have begun supplementing formula milk with long-chain polyunsaturated fatty acids (LCPUFA). The current evidence suggests that there may be little or no difference between formula milk with and without LCPUFA supplementation in terms of babies' visual function, physical growth or neurodevelopment.<ref>{{cite journal | vauthors = Jasani B, Simmer K, Patole SK, Rao SC | title = Long chain polyunsaturated fatty acid supplementation in infants born at term | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 3 | pages = CD000376 | date = March 2017 | pmid = 28281303 | pmc = 6464574 | doi = 10.1002/14651858.CD000376.pub4 }}</ref>

== See also ==
* [[2022 United States infant formula shortage]]
* [[2008 Chinese milk scandal]]
* [[Amino acid-based formula]]
* [[Baby food]]
* [[Baby bottle]]
* [[Breastfeeding]]
* [[Breast milk]]
* [[Child development]]
* [[Daigou]]
* [[Dairy allergy]]
* [[List of dairy products]]

==Notes==
{{reflist|30em|group="note"}}

== References ==
<!--See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for an explanation of how to generate footnotes using the<ref> and </ref> tags and the tag below -->
{{reflist|30em}}

==Further reading==
* Ahern, Grace J., et al. "Advances in infant formula science." ''Annual review of food science and technology'' 10 (2019): 75–102. [https://doi.org/10.1146/annurev-food-081318-104308 online]
* Almeida, Cristine Couto, et al. "Bioactive compounds in infant formula and their effects on infant nutrition and health: a systematic literature review." ''International journal of food science 2021'' (2021) [https://www.hindawi.com/journals/ijfs/2021/8850080/ online].
* Guo, Mingruo, ed. ''Human milk biochemistry and infant formula manufacturing technology'' (2020). [https://books.google.com/books?id=SdPoDwAAQBAJ&dq=%22Infant+formula%22&pg=PP1 online]
* Hastings, Gerard, et al. "Selling second best: how infant formula marketing works." ''Globalization and Health'' 16.1 (2020): 1–12. [https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00597-w online]
* Martin, Camilia R., Pei-Ra Ling, and George L. Blackburn. "Review of infant feeding: key features of breast milk and infant formula." ''Nutrients'' 8.5 (2016): 279+ [https://www.mdpi.com/2072-6643/8/5/279/pdf online].
* Rosenberg, Alyssa. "The U.S. should never have another baby formula shortage" [https://www.washingtonpost.com/opinions/2022/10/06/baby-formula-crisis-reform-plan/ ''Washington Post'' Oct 6, 2022]

== External links ==
*{{Cite web|title=Infant Formula: Second Best but Good Enough|author=Isadora B. Stehlin|website=U.S. FDA|url=https://www.fda.gov/fdac/features/596_baby.html|archive-url=https://web.archive.org/web/20071226072202/https://www.fda.gov/fdac/features/596_baby.html|archive-date=December 26, 2007}}
*[https://web.archive.org/web/20090608061753/http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048694.htm FDA 101: Infant Formula]
*[https://www.nlm.nih.gov/medlineplus/infantandtoddlernutrition.html Infant and Toddler Nutrition]

{{Infants and their care}}
{{DEFAULTSORT:Infant Formula}}
[[Category:Infant formula| ]]
[[Category:Milk]]
[[Category:Dairy products]]
[[Category:Soy products]]
[[Category:Bristol Myers Squibb]]
[[Category:Breast milk]]
[[Category:Breastfeeding]]
[[Category:Lactose]]