1. Why is breastmilk better than infant formula?
Breastmilk is the normal way to feed a baby and the best source of nutrition for healthy babies. It contains the right balance of nutrients for infants and also anti-infective agents which protect the baby against infection.

Breastmilk confers immunological advantages which may reduce the incidence of illness and which may extend into later childhood. These include not only antibodies and other immune-protective proteins, but also living cells.

2. Is mother’s milk affected by diet??

Maternal diet is important and can have an effect on breast milk. More information about healthy eating for breastfeeding mothers can be found at the following website: Australia – Healthy Eating Guidelines for Breastfeeding Women New Zealand – Eating for Healthy Breastfeeding Women/Ngā Kai Totika mā te Ūkaipō

3. What are infant formula products?

The term infant formula products is prescribed in the Australia New Zealand Food Standards Code (Standard 2.9.1) and for regulatory purposes covers all formula products made for infants 0-12 months of age. The Food Standard for infant formula products, with the exception of a minority of speciality formulas, covers the regulatory requirements for both infant formula and follow on formula.

4. What is infant formula?

The regulations in Australia and New Zealand state that infant formula means an infant formula product represented as a breastmilk substitute for infants and which satisfies the nutritional requirements of infants aged up to around six months.

5. What is follow-on Formula?

An infant formula product continues to be an important part of an infant’s diet where a baby is not being breast fed and in combination with solid foods up to 12 months of age. Follow-on formulas are designed for infants beteen 6 and 12 months of age, and are suitable as the liequid source of nourishment in a progressively diversified diet in the non breastfed infant.

6. Why is infant formula the only suitable substitute to breastmilk?

When a baby does not receive breastmilk the only suitable and safe alternative is a commercially available infant formula. Infant formula has been specifically developed to contain all the necessary ingredients needed to meet the complete nutritional requirements of infants up to the age of 6 months.

7. Are cow’s milk, fruit juice or soft drinks okay?

The National Health and Medical Research Council (NHMRC) and the New Zealand Ministry of Health’s Food and Nutrition Guidelines for Health Infants and Toddlers do not recommend giving unmodified cow’s milk as a drink to babies under 12 months. In Australia the NHMRC does state that cow’s milk can be used in solid foods from around 9 months of age while the New Zealand Ministry of Health recommends cow’s milk can be used in cooked foods (eg custard, milk pudding) from 7-8 months. For babies under a year old, cow’s milk as the principle source of nutrition is too high in protein and some vitamins/mineral levels are unsuitable which, can affect immature kidneys and may be difficult for young tummies to digest.

In order to satisfy thirst, water is the preferred beverage and it is not recommended to give babies under 12 months fruit juice or soft drinks. Both fruit juice and soft drinks can contribute to tooth decay and are not nutritionally appropriate for infants.

8. When can an infant formula product be used?

When a baby is not given breastmilk exclusively, a commercial infant formula product is the only safe and suitable alternative to breastmilk for the first 12 months of life. An infant or Follow-on formula product is suitable from 6 to 12 months. Diluted milk mixtures bason on evaporated, powdered or condensed milk are not suitable for infant feeding.

9. How do manufacturers ensure the safety and quality of infant formula powder?

Infant formula products available in New Zealand and Australia are made to stringent standards to meet the regulatory requirements for food supply in Australia and New Zealand, which is set by Food Standards Australia New Zealand (FSANZ).

The raw materials used in the manufacture of infant formula and of the final product itself must meet very strict specifications. The highest standards throughout the manufacturing process involve thorough heat treatment which ensures the microbiological safety of the product. Quality control procedures are very strict and stringent standards of hygiene are in force throughout. The risk of potential contamination is kept to an absolute minimum.

10. Are infant formulas safe for babies?

Yes. Infant formulas are very safe provided they are prepared, stored and used correctly. Attention to instructions provided by the manufacturer however must be followed to ensure safety.

11. Why do infant formula companies produce different infant formula?

Infant formula available in Australia and New Zealand comply with the essential compositional requirements of Australia New Zealand Food Standards Code and as such, are adequate in providing nutrition to infants. Infant formula can contain additional ingredients such as long chain Omega 3 & 6 fatty acids (AA & DHA) which may support infant growth and development.

By producing different formula, parents and carers are able to choose a formula for a certain ingredient, or a formula designed to meet the specific nutritional needs of their child.

12. Is infant formula full of sugar?

It is sometimes claimed that “infant formulas are full of sugar”. This statement is incorrect if the term sugar is referring to table sugar (sucrose). Sugar in the form of lactose is present in breastmilk at higher levels than cow’s milk and it is considered a very important source of readily available energy for the baby. Infant formula products have been formulated where possible to contain lactose in similar amounts as found in breastmilk.

13. Will formula feeding result in adult obesity?

There are many factors that may influence the development of obesity in adulthood and there is no conclusive scientific evidence to support a direct relationship between obesity and feeding of infant formula. There is evidence to suggest that some factors such as high energy and high protein intake in infancy is associated with increased risk of weight gain or obesity later in life. As a result, some infant formulas have moved to lower the recommended volume intake per serve (energy and/or protein content of the formula. Obesity is a multi factorial disease that is affected by many factors, including maternal diet.

14. When should soy infant formulas be used?

Soy infant formulas should only be used on the advice of a GP or other healthcare professional. Other soy based or cereal based non-infant formula beverages should not be used.

15. Is it possible to use formula while still breastfeeding?

The World Health Organization recommends exclusive breastfeeding for the first six months. However there are circumstances when exclusive breastfeeding is not possible. In these circumstances, under the advice of a health professional, it is possible to both breastfeed and formula feed an infant. The introduction of partial bottle feeding may negatively affect breastfeeding.

Partial replacement of breastmilk must only be with infant formula: unmodified cow’s milk (diluted or not) or other fluids are unsuitable and could be dangerous. The formula must be made according to instructions and no other food added to the bottle.

16. What is the correct way to use infant formula?

Always follow manufacturers’ instructions on the label to make up infant formula. Most commonly available infant formulas are powders which must be mixed with cooled boiled water in the correct proportions. Using too much or too little powder without medical advice can make your baby very ill.

Bottles and teats must be cleaned and sterilised very carefully.

It is very important that mothers receive adequate information in order to ensure the safe use of infant formulas. Manufacturers provide this information on labels and in product literature. Additional information may be sought from your healthcare professional.

The Infant Nutrition Council has developed guidelines for the safe preparation and handling of infant formula.

17. What type of water should be used to make up infant formula?

Ordinary tap water from a main water supply (community drinking water – also called reticulated or town supply) is adequate for use in preparing infant formula as long as it is boiled and cooled prior to use. Water should be taken fresh from the cold tap after running for 10 – 15 seconds.

If you have a bore, check with your local public health authority that yours is suitable for use in preparing infant formula. Bore water and tank water are safe but extra care needs to be taken when using them. They should be boiled for the preparation of infant formula products until baby is 18 months old (NZ Ministry of Health guidelines).

Questions have been asked as to whether bottled water can be used to prepare infant formula. Food Standards Australia New Zealand has stated that plain bottled water (but not natural or sparkling mineral water or soda water) may be used to prepare infant formulas. As with tap water, these should be boiled and cooled before they are used to prepare infant formula according to the instructions on the formula package label.

18. Why does the water need to be sterilised before making up infant formula?

For hygiene reasons, the water used to make up feeds needs to be sterile. Manufacturers recommend that water is boiled and allowed to cool before making up feeds. Bottles and teats must also be sterilised.

19. Can I prepare infant formula and keep it in the fridge?

There is some variation in guidelines about the storage of made up infant formula. The Australia New Zealand Food Standards Code states that “if a bottle of made up infant formula is to be stored prior to use, it must be refrigerated and used with 24 hours”.

The Infant Nutrition Council recommends where possible that each infant feed be made up individually just prior to use. Always follow manufacturers’ instructions about how to make up and store infant feeds. Any formula that has been made up in advance with boiled water must be refrigerated if not to be used immediately, and in any case must be used within 24 hours, or discarded.

Unfinished feeds must always be discarded and never kept for use in a later feed.

The Infant Nutrition Council has developed guidelines for the safe preparation and handling of infant formula.

20. Can I store Ready to Drink infant formula in the fridge once it is opened?

The Infant Nutrition Council recommends where possible that each infant feed be prepared individually, just prior to use. Always follow manufacturers’ instructions about how to prepare and store infant feeds.

‘Ready to Drink’ infant formula products are available in aseptically packed glass bottles for hospital use only or in aseptically packed tetra packs for home use. However once opened, prior to use either “Ready to Drink’ formats (glass bottle or tetra pack) may be prepared into numerous sterilized bottles provided that these bottles are refrigerated below 4 °C continuously and used within 24 hours.

Any unfinished formula left in the bottle after a feed must be discarded and never kept for use in a later feed.

21. Can I keep warm formula that has already been made up in a vacuum flask?

No. This is definitely not recommended. Boiled water may be stored in a vacuum flask and the feed mixed when required; but never keep milk warm for any period of time as warm milk is an ideal breeding ground for bacteria.

22. Can I freeze infant formula?

Freezing made-up formula is not recommended.

23. Should you take out bottles already made up?

It’s much safer to prepare bottles of infant formula at your destination, rather than carrying around bottles of prepared formula you’ve made up at home hours earlier.

Harmful bacteria thrive in warm, moist conditions. Ready-made bottles of prepared formula can be a breeding ground for bacteria if they’ve been sitting in a car or baby bag for many hours, especially on a warm day. Some bacteria can be harmful to babies as it has the potential to cause illness. When preparing formula always follow the instructions on the package.

24. How do you heat up infant formula?

Infant formula that has been prepared in advance and stored in the refrigerator (for no longer than 24 hours) can be heated up by standing in a pot of warm water.

Never, put your baby’s bottle into the microwave. Microwaves can create uneven ‘hotspots’ in the water and can potentially burn your baby’s mouth.
Before feeding, test the temperature of the formula by putting a few drops on the inside of your wrist. If it’s body temperature then it will feel neither too hot nor too cold and is at the right feeding temperature for your baby to drink.

25. How do you transport water and portions of formula?

There a number of containers available that are designed to carry single serves of infant formula which are ideal if you are taking your baby out during feed times. Ensure to check the manufacturer’s instructions. We also suggest taking a separate sterilised bottle (or numerous sterilised bottles) of cooled boiled water at the correct volume, so you can make up the formula when you need it and feed immediately. But remember, wherever you are, follow the manufacturer’s instructions provided on the tin or pack of infant formula.

26. Should you always take enough supplies for extra feeds just in case?

Yes, it’s best to be over prepared than have an unhappy and hungry baby. It’s also a good idea to take extra sterilised bottles as washing bottles re-using bottles without being properly sterilised is not advised.

27. Can parents buy single-serve sachets or ready-to-drink formula?

Yes, you can buy single-serve sachets of infant formula powder that can be made up or packs of liquid infant formula that are available in UHT style packaging that is ready to drink without need for mixing. The liquid formula needs to be poured into a sterilised bottle and can be warmed in the bottle if desired, just before feeding. These are safe, hygienic and convenient to use. Again, it’s important to follow the manufacturer’s instructions provided on the pack.

28. What is E. Sakazakii and should I be concerned about it?

E. sakazakii also known as Cronobacter sakazakii is a bacterium which can cause severe illness in the infant. It is an opportunistic pathogen which is quite common in the environment. E. sakazakii infection in infants is very rare. However, when it does occur, susceptible population groups are generally very young or immunocompromised infants and the cause is generally due to unsafe preparation and storage of liquid feeds.

Infant formula manufacturers are committed to providing safe products and they do so by applying stringent hygiene measures to ensure their safety and compliance with regulatory standards in the manufacture of such products. In terms of microbiological safety, preparation and handling must adhere to strict hygiene rules and immediate consumption after preparation represents the safest option.

You should not be concerned, provided you follow the manufacturer’s instructions exactly on safe preparation and storage of infant formula. Further information on E. sakazakii can be found here.

29. How important is research to infant nutrition?

It is very important. The infant formula industry plays a major role in improving infant and young child health through its substantial investment in research and development. Much of the present knowledge of the benefits of breastmilk is a direct result of research supported by the industry. The results of this research are used to further our knowledge of infant nutrition and, in turn, to develop new products and improve existing products.

30. Is self regulation of the formula industry successful in Australia and New Zealand?

Yes, the infant formula manufacturers and importers who are members of the Infant Nutrition Council are committed to restricting their marketing practices of infant formula to support the public health goals to protect and promote breastfeeding.

Infant Nutrition Council members are signatories to the Marketing in Australia of Infant Formulas: Manufacturers and Importers Agreement 1992 (MAIF Agreement) in Australia and have adopted the Infant Nutrition Council Code of Practice for the Marketing of Infant Formula in New Zealand (INC Code of Practice).

These interpretations give effect to the principles and aim of the World Health Organization International Code of Marketing of Breast Milk Substitutes (WHO 1981) (WHO Code) as appropriate to the social and legislative framework in Australia and New Zealand. The MAIF Agreement and the INC Code of Practice apply to the manufacturers and importers of infant formula and prescribe how information about infant formula can be distributed.

The Australian and New Zealand governments are responsible for monitoring compliance with the local industry Codes. They each have a complaints’ process to accept and investigate any claims of breaches. The Advisory Panel on the Marketing in Australia of Infant Formula (APMAIF) and the Compliance Panel in New Zealand meet regularly to review complaints and decide if a breach has occurred. These panels are appointed by government and are independent from the manufacturers and importers of infant formula.

31. In what ways does the Infant Nutrition Council support and protect breastfeeding in Australia and New Zealand?

Infant Nutrition Council members voluntarily self regulate their marketing practices through their adherence to the local interpretations of the WHO Code and also through the Infant Nutrition Council’s own Competitive Complaints Procedure.

The Infant Nutrition Council is committed to working in partnership with government, regulatory authorities, health care professionals and breastfeeding advocates, to support the public health goals for the protection and promotion of breastfeeding and to improvew the health and wellbeing of infants in Australia and New Zealand.

32. Where can infant formula products be advertised?

It is not permitted to advertise infant formula (suitable for infants up to the age of 12 months) to the public in Australia. For example, there is no consumer advertising of infant formula, and this includes TV, radio, newspapers, parent craft and baby magazines. In New Zealand it is not permitted to advertise infant formula (suitable for infants up to the age of 6 months) to the public. The INC Code of Practice in New Zealand, only applies to infant formula, for infants 0-6 months of age. Information on infant formula for healthcare professionals in professional journals is permitted to keep healthcare professionals informed about new product developments so that they can advise mothers accordingly

Information on infant formula to the Trade is also permitted to inform pharmacists and retailers of the latest product developments and prices.

33. Are manufacturers and importers of infant formula allowed to communicate with health professionals?

Yes, they are allowed to communicate with health professionals. Manufacturers and importers of infant formula are obliged under the WHO Code and the Australian and New Zealand interpretations; the MAIF Agreement and the INC Code of Practice to provide health care professionals with information about infant formula when necessary. This information must be restricted to scientific and factual matters and must not create a belief that infant formula is equivalent or superior to breastfeeding.

Healthcare professionals have a responsibility to be fully familiar with each of the formulas and the differences between them to ensure that mothers who are using infant formula receive adequate and appropriate information.

Indeed it is a requirement under both the WHO Code and the NZ Code of Practice for Health Workers that healrcare professionals provide information about infant formula when necessary.