Feeding Issues

    Helping parents manage common feeding issues just got easier.

    Tummy issues and Feeding Concerns for Moms

    When moms have a baby who is fussy, gassy and crying, they come to you for answers. Sometimes a little parent education can go a long way in easing their issues. For breastfeeding babies, it may help to counsel moms to recognize their baby’s hunger signals or watch out for certain foods in their own diet. For formula-feeding babies, changes in formula type may be what they need.

    Help educate parents to ease and enjoy feeding times with their infants. Download this FAQ for parents about easing gas and crying.

    Download FAQ

     

    What causes tummy issues?

    Problems digesting some nutrients, such as protein and lactose, may be presented as fussiness or gas in some infants, and it is common practice to consider a change in formula at this time.

    The enzymes lactase and enterokinase are involved in the breakdown of lactose and protein, respectively, in the digestive system. Due to the immaturity of the digestive system in infants, these enzymes may not be produced in adequate amounts resulting in some lactose and protein traveling to the large intestine without being fully digested. They may be fermented by bacteria.

    Bacterial fermentation in the large intestine may cause gas, which may lead to fussiness or crying.

    Research suggests enzyme activity may be reduced in infants at birth 2,3

    Lactase

    Enzyme that breaks down the lactose

    Enterokinase

    Activates enzymes that break down protein

    A Range of Formula Options

    Standard milk-based formulas have intact proteins derived from cow’s milk. Some formulas are now available that contain intact A2 betacasein proteins, which are naturally easy to digest.

    Through a process called hydrolysis, intact proteins can be broken down during manufacturing. Formulas with partially hydrolyzed proteins are designed to help ease digestion4. Extensively hydrolyzed formulas should be considered for cases in which cow’s milk allergy is suspected. For infants with galactosemia or hereditary lactase deficiency, or in cases in which families may prefer a plant-based infant formula, soy formula should be used5.

    Recommending the correct formula can help your patients and give parents peace of mind.

    The Right Solution for Every Baby

    Formulas with a reduced amount of lactose may help with digestive comfort while providing some lactose as an energy source for babies’ growth. Lactose also shapes the intestinal microbiota and promotes the absorption of some nutrients such as calcium6. Because lactose only acts as a source of energy for gut microbes when it is undigested, this may indicate lactose intolerance.

    Intact Protein Formulas with Full Lactose

    Healthy babies’ first choice when breastfeeding is not possible.

    Routine Formulas

    Intact A2 Protein Formulas with Full Lactose

    A2 beta-casein is similar to the protein found in breast milk and is naturally easy to digest.

    A2 Formula

    Intact Soy Protein Formulas with No Lactose

    Soy-based formula should be used when a plant-based protein formula is preferred, or in infants who have galactosemia or confirmed hereditary lactase deficiency5.

    Soy Formula

    Partially Hydrolyzed Formulas with Reduced Lactose*

    Offering partially broken-down proteins and reduced lactose may help an infant’s immature gut.
    • 73% of babies in the U.S. experience digestive discomfort1
    * Approximately 20% of a full-lactose, routine formula

    Partially
    Hydrolyzed Formula

    Extensively Hydrolyzed Formulas with No Lactose

    For confirmed or suspected cow’s milk protein allergy (CMA).
    • 2% to 7.5% of babies experience CMA7

    Extensively
    Hydrolyzed Formula

    How hydrolyzed formulas work

    Partially hydrolyzed formulas are easy to digest, and they can help with mild gastrointestinal issues4.

    Extensively hydrolyzed protein formula is the first-line recommendation for infants with cow’s milk allergy. Learn more about the science behind extensively hydrolyzed formulas:

    See the Science

    When is soy formula appropriate?

    Although popular in the U.S., soy-based formulas have limited indications from expert groups like the American Academy of Pediatrics (AAP).

    Many parents turn to soy formula because they believe their infant has indications of a feeding intolerance or food allergy, such as spit-up, vomiting or fussiness5. However, there is no evidence that soy formula helps prevent or manage these indications5. In infants with cow’s milk allergy, the AAP recommends switching to an extensively hydrolyzed protein formula, as 10-14% of infants with CMA may also have an allergy to soy5.

    Soy-based formulas do support normal growth and development in term infants, but it is important to note that they are not appropriate for premature infants due to a higher risk for osteopenia, even when supplemented with calcium and vitamin D5.

    The AAP does recommend soy formula for these indications5:

    •  Infants with galactosemia

    •  Infants with hereditary lactase deficiency

    •  Families who prefer a vegetarian option

    Read the AAP’s full guidance for soy-based formulas:

    Read the Recommendation

    What is A2 milk?

    A2 is a type of beta-casein protein that is found in cow’s milk. There are two types of beta-casein proteins in milk, A1 and A2. It’s believed that cows used to produce only the A2 protein but at some point, a mutation occurred.

    The difference between the milk protein in A1 and A2 milk is only one amino acid—but this little difference potentially impacts how some bodies react to the milk protein.

    Emerging evidence from studies in preschool children and adults suggests that A2 milk is less likely to be associated with digestive discomfort.

    Looking for Formula Solutions for Your Patients?

    Learn more about Mead Johnson Nutrition’s solutions for mild digestive issues:

    See Solutions

    It’s Time for a Gut Check

    When to Recommend a Probiotic Supplement

    Emerging data show that probiotics may be beneficial for supporting overall digestive and immune health(8-10). Fostering a healthy infant gut microbiome regularly—not just after a bout of gastroenteritis or following a round of antibiotics—may be beneficial for baby.

    Learn more about the link between gut bacteria and immune health.

    Read the Review

     

    Strains Matter

    Probiotics Most Commonly Used in Infant Nutrition

    Lactobacillus rhamnosus GG (branded LGG®)
    The most widely studied probiotic, LGG has been used in food and dietary supplements for close to 30 years with a well-documented safety and efficacy profile.

    Bifidobacterium lactis (BB-12®)
    Also well-studied, BB-12 may have beneficial effects on gastrointestinal and immune function.

    Lactobacillus reuteri (RC-14®)
    Originating from healthy vaginal sources, this strain has been used safely since 2004.

    Lactobacillus reuteri (DSM 17938)
    This strain was isolated from the breast milk of a woman living in the Andes.

     

    Nourishing a Robust Microbiome Can Help Support Digestive and Immune Health

    Depending on the strain, probiotics may help your infant patients in the following ways:

    • Improve gut barrier function11
    • Support immune health8
    • Lower risk of atopic/allergic disease9
    • Ease digestion issues like colic8

    While most studies at this time revolve around individual strains, emerging evidence suggests combining some probiotic strains can have synergistic effects9.

     

    Provide Your Patients with Clinically Studied Levels of LGG® and BB-12® Probiotics

    See the options Mead Johnson Nutrition has to offer.

    See Probiotic Options

    LGG and BB-12 are trademarks of Chr. Hansen A/S.

    Could GER or GERD be causing your patient's spit-ups?

    GER Occurs in 66% Healthy Infants12

    Healthcare professionals understand that babies spit up, but parents often worry about it. A lot. In fact, research shows that spit-up is the topic of discussion at 25% of routine 6-month visits12.

    GER is common—it can occur daily in 50% of all infants. Spit-up, regurgitation or vomiting are often the most visible symptoms.

    Knowing the difference between uncomplicated physiologic reflux (GER) and actual gastroesophageal reflux disease (GERD) is key in managing symptoms—and reassuring worried parents.

    Identify the Source of Spit-Ups

    GER is a normal physiologic process caused by an immature lower esophageal sphincter (LES). In younger infants, the LES isn’t strong enough to prevent backflow from the stomach to the esophagus. As the LES matures, GER usually resolves on its own.

    Common Causes of GER

    Overfeeding

    Positioning during/after feedings

    Burping frequency

    Intolerance to maternal diet
    (e.g., milk or egg)

    Type of formula used

    Current Guidelines for Managing Reflux

    Many worldwide expert groups have published recommendations on managing GER and GERD, including the American Academy of Pediatrics. According to their latest guidelines, it is critical to properly distinguish between GER and GERD. In either case, lifestyle changes are the first-line treatment12. This includes:

    • Making feeding changes
    • Positioning therapy
    • Modifications of maternal diet (if breastfeeding)
    • Reducing feeding volume
    • Increasing feeding frequency
    • Educating parents about avoiding environmental factors such as tobacco smoke

    Empiric use of acid suppression medication is not indicated for uncomplicated physiologic reflux. Additionally, in April 2020, the FDA requested that all prescription and over-the-counter products containing ranitidine be pulled from the market due to safety concerns13.

    If there are signs of more complicated GERD, closer evaluation is needed. The newest guidelines emphasize weight loss as a critical warning sign. Subspecialist consultation and pharmacologic treatment may be warranted.

    Figure 1. Approach to the infant with recurrent regurgitation and vomiting 12

    Do Thickened Formulas Work for GER?

    When managing GER, choosing a thickened formula may work for otherwise healthy, non-breastfeeding infants. Commercially available thickened formulas offer a more balanced nutrient profile with less mess.

    By using ingredients such as rice starch, for example, formula flows normally through a standard nipple, only thickening when “activated” by the gastric juices of the stomach.

    Energy of thickened formulas meets the recommended 20 kcal/serving, while adding rice cereal to standard formula can increase the energy density to 34 kcal/serving, effectively diluting the protein and fat ratios.

    See Formula Option

     

     

    Educating Parents on GER Management

    Providing education and reassurance is an important step in helping parents manage GER in their infant. Use this dialogue tool to discuss lifestyle changes to ease stress on parents and help manage their infant's symptoms.

    Download Parent Educator

     

    References

    GER = gastroesophageal reflux
    GERD = gastroesophageal reflux disease

    1. Quantitative online digestive concerns survey. Moms with babies from 0-12 months. Intuit Research Agency, July 2019. Scope: MX, PH, TH, US, CN. N=200 per market.
    2. González HL et al. Acta Pediatr Mex. 2005;26:270-292.
    3. Cummings JH et al. J Appl Bacteriol. 1991;70:443-459.
    4. Berseth CL et al. Clin Pediatr (Phila). 2009;48:58-65.
    5. Bhatia J, Greer F, Committee on Nutrition. Use of Soy Protein-Based Formulas in Infant Feeding. Pediatrics. 2008;121(5):1062-1068.
    6. Romero-Velarde E, Delgado-Franco D, García-Gutiérrez M, et al. The Importance of Lactose in the Human Diet: Outcomes of a Mexican Consensus Meeting. Nutrients. 2019;11(11):2737. doi: 10.3390/nu11112737
    7. Vandenplas Y et al. Arch Dis Child. 2007;902-908.
    8. Scientific Committee on Food, European Commission, Health and Consumer Protection Directorate-General. Report of the Scientific Committee on Food on the Revision of Essential Requirements of Infant Formulae and Follow-on Formulae. Brussels, Belgium: European Commission, Health and Consumer Protection Directorate-General; 2003. Kwak H-S et al. Int Dairy J. 2012;22:147-151.
    9. Nocerino R et al. Aliment Pharmacol Ther. 2020;51:110-120.
    10. Schmidt et al. Pediatr Allergy Immunol. 2019;30:335-340.
    11. Hojsak I et al. Clin Nutr. 2010;29:312-316.
    12. Johnson-Henry KC et al. Infect Immun. 2008;76(4):1340-1348.
    13. Lightdale JR, Gremse DA and Section on Gastroenterology, Hepatology, and Nutrition. Pediatrics. 2013;131:e1684-e1695.
    14. Korioth T. FDA wants all ranitidine products off the market. AAP News. Published April 1, 2020. Available at: https://www.aappublications.org/news/2020/04/01/ranitidine040120. Accessed June 17, 2020.