Kross posting...

*American Academy of Family Physicians*
presents KidsHealth
on familydoctor.org

AAP Updates Its Stance on Soy Formula

Many parents assume that formula plays a role in a baby's fussiness or colic
— and that switching from cow's milk formula to soy-based formula (made from
soybean proteins) will help. But that's not the case, says a new clinical
report by the American Academy of Pediatrics (AAP) that revises the
organization's 10-year-old position on soy formula.

Although many parents think soy formula is the obvious alternative for
formula-fed babies who are allergic to cow's milk, the fact is that 10% to
14% of infants with a cow's milk allergy also have a soy protein allergy so
a hypoallergenic formula should be considered, says the AAP. Hypoallergenic
formulas should also be given to infants who have had a severe
gastrointestinal reaction (abdominal pain with bloody diarrhea) to cow's
milk, since anywhere from 30% to 64% of babies will also have a similar
reaction to soy.

Considering that most babies in North America are drinking some kind of
infant formula by 2 months old, with soy formula making up almost a quarter
of U.S. formula sales, the pediatricians' group wants to make it clear that
there are actually very few reasons to give babies soy formula instead of
cow's milk formula — even if both contain the nutrients babies need.

According to the AAP, the only formula-bed babies who should get soy formula
are those with:

  - parents who are strict vegans (vegetarians who don't eat red meat,
  poultry, fish, or any products that come from animals like eggs or dairy
  products)
  - a true diagnosis of lactose intolerance, which is actually rare in
  babies but more common among older kids and adults. Not the same thing as an
  allergy to cow's milk, lactose intolerance is the inability to digest the
  sugar lactose, found in cow's milk and cow's milk infant formulas. So,
  babies can have soy formula because it's "lactose free."
  - congenital galactosemia (in which babies lack the enzyme that converts
  galactose — one of two sugars found in lactose — into glucose, a sugar the
  body is able to use). If these children consume breast milk, cow's milk, or
  other dairy products, galactose can build up in the system and damage the
  body's cells and organs, leading to blindness, severe mental retardation,
  growth deficiency, and even death.)

The AAP report also addresses the concern about "phytoestrogens" found in
soy formula, including a type of estrogen called "isoflavones" (found in
legumes like peas and lentils, but occurring in the highest concentrations
in soybeans). What they found: "there is no conclusive evidence from animal,
adult human, or infant populations that dietary soy isoflavones may
adversely affect human development, reproduction, or endocrine function."

But the AAP emphasizes that soy formula is not created or recommended for
premature babies.
What This Means to You

All of the major health organizations agree that breast milk is the best
form of nutrition for babies for at least the first 6 months. And, if both
the mother and little one are willing, nursing should ideally continue —
even after introducing solid foods — until the first birthday (and even
beyond).

Although both cow's milk and soy-based formula do provide infants with the
nutrients they need, breastfeeding is considered ideal because:

  - breast milk is much easier for babies to digest and naturally contains
  all the vitamins and minerals a newborn requires
  - studies show it can lower the occurrence or severity of diarrhea, and
  reduce the number of respiratory infections and ear infections
  - it may provide babies with protection from diabetes, eczema, asthma,
  and sudden infant death syndrome (SIDS)
  - research indicates that it decreases nursing moms' risk of type 2
  diabetes and ovarian and breast cancer

But for mothers who can't breastfeed, or decide not to, iron-fortified
infant formula is a good alternative.

For babies who are allergic to the protein in cow's milk formula (although
many children typically outgrow a milk allergy by 2 or 3 years old),
symptoms of an allergic reaction may include:

  - vomiting
  - diarrhea
  - abdominal pain
  - rash
  - even some blood in the baby's stools

If a cow's milk allergy turns out to be the culprit behind your baby's
discomfort, your doctor may recommend a hypoallergenic formula (an
extensively hydrolyzed protein formula or an amino-acid-based formula that's
easier to digest) not soy formula — since many babies can't tolerate the
cow's milk or soy-based formulas.

However, some babies may not be allergic to cow's milk at all, but could
instead have lactose intolerance, which tends to develop over time and may
cause symptoms like:

  - excessive gas
  - abdominal swelling and pain
  - diarrhea

Babies also may become temporarily lactose intolerant after they get an
intestinal infection. Though most infants do well when reintroduced
to breast milk or cow's milk formula following a bout a diarrhea, in some
instances the doctor may recommend using soy formula or lactose-free formula
during recovery.

Before making the decision to switch formulas for any reason, be sure to
talk to your doctor since these symptoms could indicate something else
altogether. Plus, hypoallergenic formulas can cost up to three times more
than standard cow's milk or soy formulas, another reason to make sure your
baby has a true milk protein allergy before you make the switch.

Reviewed by: Mary L. Gavin, MD
Date reviewed: May 2008
Source: "Use of Soy Protein-Based Formulas in Infant Feeding," *Pediatrics*,
May 2008

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