The American Academy of Pediatrics AAP's latest recommendations: what milk to drink for babies over 1 year old

433rd original article

I've recently noticed that the American Academy of Pediatrics (AAP) has made a similar noise. In the [Clinical Guidelines and Clinical Reports] section of the 2023.10 section, the AAP official website released a clinical report entitled "Larger Infant Formula" (hereinafter referred to as the "Report"). Based on the existing evidence, the report explores how much "help" infant formula can provide for babies who have failed to breastfeed exclusively, whether it is really as nutritious as advertised, and whether there are hidden dangers.

Among them, a large amount of analysis and discussion focuses on the "necessity" of "infant formula milk", that is, those formula milk whose user group is babies over 12 months old.

During the discussion, the report presented:

The U.S. FDA does not have any ingredient standards or definitions for formula milk for children over 12 months of age and children, and there is no corresponding supervision and regulation.

Worldwide, although expert organizations in some countries and regions have indeed made relevant recommendations on the composition and content of this category, there is still a lack of unified international standards.

Within the U.S., the composition of the formulations varies widely (because there are no standards and market surveillance). Some of these formulas have been blamed/criticized for containing unnecessary ingredients or potentially harmful ingredients, including but not limited to high or low protein content, higher sodium content than fresh milk, added sweeteners, etc.

It has been pointed out that the consumption of formula milk containing added sweeteners to young children may lead to an increase in the intake of sugar-sweetened beverages and sugary dairy products (e.g. fruit-flavoured yogurt, cream cheese desserts) due to the impact on the taste preferences of young children and children.

Formula milk over 12 months of age is "nutritionally incomplete" and is designed for healthy toddlers and children with normal growth and development. "Function" is to replace or supplement whole milk or breast milk that should be included in the diet. Therefore, these products cannot be used in medical nutrition therapy, that is, they cannot be used in children with problems such as growth retardation (e.g. malnutrition, failure to thrive, etc.), swallowing dysfunction, feeding difficulties, cerebral palsy, or special nutritional needs due to certain diseases (e.g. celiac disease, gastrointestinal diseases, inherited metabolic diseases, food allergies or intolerances).

The diet of children in the United States is generally rich in most of the micronutrients they need to grow and develop. However, in some cases, a small number of children may have insufficient intake of nutrients such as vitamin D, E and dietary fiber. However, milk sold in the U.S. is fortified with vitamin D. For most children, formula milk is not a necessity and tends to be more expensive.

I will not move the bricks one by one for the statements on label statements, market and consumption analysis, etc. Let's skip straight to the [Advice] section at the end and see what the attitude of AAP is.

AAP recommends:

For infants less than 12 months of age, the liquid food in the diet should be provided by breast milk or standard infant formula that has been reviewed by the FDA Infant Formula Act.

For toddlers and children aged 12 months and older, caregivers should provide nutritious and varied meals whenever possible. While formula milk is safe for these children, it is not nutritionally advantageous and more expensive than breast milk (preferred) and/or plain milk for most children with a balanced diet. Therefore, formula milk should not be marketed as "nutritional".

The marketing of formula over 12 months of age should be clearly distinguished from standard infant formula in promotional materials, labelling, product names and packaging. Products in this category should not be associated with standard infant formula in any way (be it numbers, stages, sequential names, etc.) and should be labelled as products other than "formula" rather than "formula". For example, a follow-up or toddler "drink" or "drink" instead of a follow-up or toddler "formula". On the shelves of supermarkets, products over the age of 12 months should not be placed with standard infant formula.

Encourage your health care team to include family education for these products in your childcare education.

Healthcare providers and care teams should focus on nutritional assessment of young children and children, pay attention to the intake of mineral- and iron-rich solid foods, and adjust solid food intake and/or vitamin and mineral supplementation as appropriate.

After reading the above, I don't know what you think?

My personal attitude is as follows, just for reference.

My personal attitude:

The AAP's recommendations are based on the fact that the U.S. FDA does not have a national standard for formula milk over 12 months of age. However, our country will begin to enforce in March 2023 that has clear regulatory requirements for this category.

Parents who like to buy pure imported formula milk, I personally think: it is not necessary. On the one hand, babies over 12 months old already rely mainly on three meals to provide nutrition, on the other hand, our new national standard "National Food Safety Standard for Infant Formula Food" (GB 10767-2021) is actually very strict, stricter than many countries. And, where there is a national standard, there is market supervision, which is very important for consumer protection!

Compared with pure milk, there is little difference in calorie value per 100 ml of formula milk over 12 months of age, but the protein content of formula milk is 35-50% lower than that of pure milk (different formula milk and pure milk content is different), and the carbohydrate content is relatively high (formula milk is generally 7-8g/10ml, pure milk is 5-5.5g/100ml). Therefore:

If your baby's milk intake is 500ml a day, a child who drinks formula milk will consume 8-10g less protein and 10-15g more carbohydrates per day than pure cow's milk. If this amount is converted into natural food, it is equivalent to eating 1 tael of lean meat and 2-3 sugar cubes more.

For children who already have a high protein content in solid foods, if they change formula milk to pure milk, I personally recommend reducing the total amount of meat, poultry, fish, shrimp and eggs to avoid excessive protein intake. Many parents think that more protein is better, but this is not the case. Children don't need as much protein as parents think, and too high protein intake will increase the risk of overweight and obesity in children, adolescents and adults.

For children with a low intake of meat, eggs, fish, shrimp and tofu in three meals, choosing pure milk as the main dairy product can make up for the concern of insufficient protein intake through solid foods.

Even though the new national standard requires that the lactose content of carbohydrates in formula milk should not be less than 50%, parents should still pay attention to cleaning their children's mouths in time. Lactose can also be fermented by oral bacteria, increasing the risk of tooth decay.

Whether babies over 1 year old should drink fresh milk or formula milk must be adjusted individually. Diet and nutritional status must be assessed, rather than simply defined. For children who eat too simple solid foods or have too low nutrient density, formula milk can be the primary option. For children who have eaten better and richer solid foods than adults, fresh milk can be used as the main or only source of dairy products in their diet, but it is necessary to pay attention to vitamin D supplementation.

—— End of the full text ——

(The picture in the article is from the Internet)

Otherwise, you may not be able to find me at any time

Sui Qian shattered his thoughts

Nutrition is very individual

Profile of the owner of the cottage

Liu Suiqian: Australian DAA Certified Registered Practicing Dietitian (APD), Certified Registered Dietitian of the Chinese Nutrition Society, Member of the Australian DAA and Chinese Nutrition Society, Master of Clinical Nutrition (MND) of the University of Sydney, and holds a Graduate Course Certificate in Pediatric Nutrition from Boston University School of Medicine。 He is a member of the translation committee of "Krause Nutrition Diagnosis and Treatment" and other translations, and is the author of many magazines and media nutrition columnists, and has edited five sets of maternal and infant books, and is the author of the book "7 Lessons on Baby Feeding, Say Goodbye to Anxiety and Start with Food Education". In the past 17 years, in the face of clinical elderly and young maternal patients, it has been determined that prevention and psychological support are the direction of doctors' help and healing - the road of popular science, and we work together.

Bibliography:

George J, et al. 

Older Infant-Young Child “Formulas”. Pediatrics (2023) 152 (5): e2023064050.

WHO Guideline for complementary feeding of infants and young children 6-23 months of age. https://www.who.int/publications/i/item/9789240081864

Food safety standard data retrieval platform https://sppt.cfsa.net.cn:8086/db

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