When was formula feeding introduced

In this book, Rima D. As infant feeding became the keystone of the emerging specialty of pediatrics in the twentieth century, the manufacture of infant food became a lucrative industry.

More and more mothers reported difficulty in nursing their babies. While physicians were establishing themselves and the scientific. Do these nurses in the s breastfeed these babies? If so, I learnt that when a woman is pregnant then the body starts producing milk for the baby in this case how can an old woman past the age of reproduction produce milk for a baby? Women can lactate without pregnancy! I'm an adoptive mother, who breastfed. I had to supplement with formula, but produced a significant amount of milk, just by having the baby suckle a lot.

These days, adoptive mothers usually use a good breast pump and the medication, domperidone, which increases the amount of milk they produce, but the vast majority of moms will produce a significant amount, from suckling a baby, alone. This has been done throughout history. Post-menopausal women can do it, too. Ovaries are not even required. The main hormone responsible for lactation, prolactin, comes from the pituitary gland.

Here is a history of infant feeding from the Journal of Perintal Education that might help answer your questions. Comments are not published until reviewed by NCpedia editors at the State Library of NC , and the editors reserve the right to not publish any comment submitted that is considered inappropriate for this resource. Handling and storage of milk improved. The biochemical differences between the major components of human milk and cow's milk had been defined.

Even at the beginning of the 20th century, it was generally appreciated that infant formulas based on cow's milk required the addition of water and carbohydrate. A number of commercially prepared formulas were patented. Liebig's food for infants, marketed in as a liquid and subsequently as a powder, consisted of wheat flour, cow's milk, malt flour and potassium bicarbonate Forsyth — , Smith Other formulas were introduced in rapid succession; by , 27 brands of patented infant foods were available Bracken However, relatively few infants were fed commercially prepared formulas.

In , general sanitation and dairying practices, although better than in the past, were still quite primitive by current standards. Seamless rubber nipples, which could be fitted over the necks of feeding bottles had become available but were apparently not widely used Brennemann ; thus, cleaning of bottles and nipples was generally unsatisfactory. Means for safe storage of formula in the home were not generally available, and adulteration of milk was common.

The possibility that inadequate intakes of vitamins or of trace minerals could lead to disease had not been considered. Energy for heat and work. Foods consist of the nutrients protein fat and carbohydrates and various mineral salts. Although reliable data on the prevalence of breast-feeding during the early years of the 20th century are not available, comments in the literature suggest that most infants were breast-fed throughout most of y 1 of life, many of them also being fed some formula [see, e.

There is reason to believe that formula feeding in the early s was less successful in the United States than in Europe. In Europe, at least in Germany, milk was almost uniformly boiled for use in infant formulas, whereas in the United States, raw milk was most commonly used Brennemann The strong prejudice against the use of heat-treated milk was based on the observation that scurvy occurred primarily in infants fed sterilized, condensed or pasteurized milk American Pediatric Society The aim was to provide a formula with a composition close to that of human milk but taking into account the digestive capability of the individual infant.

Formula preparation was so complex that it was commonly performed in commercial laboratories dedicated to this purpose. With the endorsement of Rotch, the Walker-Gordon Farm had been established in for the production of clean milk Morse and Walker-Gordon Laboratories, which used this milk, were in operation in many cities in the early s Friedenwald and Ruhrah , Morse In retrospect, although the system of formula preparation was unnecessarily complex, the formulas prepared by the Walker-Gordon Laboratories were made with care, were unlikely to be seriously contaminated with pathogens and were therefore generally more satisfactory than formulas made in the home.

By , clean milk was generally available in New York City Rosen and it seems likely that similar improvements in dairying practices and milk handling had occurred in much of the United States. Rubber nipples that could be readily cleaned had come into widespread use Brennemann , and safe storage of milk in many homes had become possible because of the availability of the kitchen icebox Fig.

Nevertheless, even in the s, formulas varied considerably in energy density. Those fed from to to infants under the care of the Infant Welfare Society of Chicago Grulee et al. Changes in infant feeding and nutrition from to major improvements in sanitation, dairying practices and milk handling occurred from to ; sterilizable rubber nipples and the home icebox became widely available by ; beginning in the early s, feeding of orange juice and cod liver oil resulted in decrease in the prevalence of scurvy and rickets, and use of boiled or evaporated milk in formula preparation from the mids resulted in infant formulas with lower curd tension and less bacterial contamination.

As reviewed by McCollum , a number of animal studies in the late s and early s had demonstrated that, despite the scientific consensus of the time, diets containing protein, fat, carbohydrate and mineral salts were inadequate to support life. Physiologic evolution, I believe, has made some of these well nigh as essential as are the basal constituents of the diet. Although scurvy of the adult had been recognized as early as [citation of Bachstrom by Stewart and Guthrie ], the relation between infantile scurvy and scurvy of the adult was slow to be recognized.

It was largely through the efforts of Hess that it became customary in the s to supplement the diets of infants with fruit or vegetable juices McCollum The prevalence of infantile scurvy then decreased substantially.

As urban living in the United States increased during the late s and early s, infantile rickets increased. The Russian pediatrician, Schabad, in a series of reports published between and , demonstrated that cod liver oil was effective in curing and preventing rickets Holt In , Mellanby demonstrated that a fat-soluble substance could prevent rickets in puppies; in , McCollum and co-workers demonstrated that the fat-soluble substance was not vitamin A.

Use of cod liver oil as a prophylactic measure against rickets became widespread in the United States by the mids. By the mids, when it was known that infantile scurvy could be prevented by daily feeding of fruit juices, the prejudice against use of boiled milk in infant formulas disappeared and formula feeding became much more successful.

To modify curd tension, lactic acid was commonly used. The use of lactic acid rather than lime water for modifying curd tension may have occurred because of the advantage of acidified over alkalinized formulas in inhibiting bacterial growth. Evaporated milk was first marketed by Gail Borden in Wharton ; beginning in , it was sold in hermetically sealed cans sterilized by heat. However, because of fear of producing scurvy, it was not used in infant feeding until the s, when its use was promoted by several of the leading pediatricians of the time Brenneman , Marriott , Marriott and Schoenthal Evaporated milk was relatively inexpensive, could be stored at room temperature and was free of bacterial contamination until the can was opened.

The processes of evaporation, homogenization and heat treatment resulted in physical changes in the milk, with an increased percentage of casein adsorbed to the surface of the fat globules Council on Foods a , thus contributing to the reduction in curd tension.

Although cereal was commonly included as a constituent of infant formulas in the early s, the purpose of its inclusion was the reduction of curd tension, not as an energy source. With the use of evaporated milk for infant formulas, cereal was no longer needed. She pointed out that in Holt's The Diseases of Infancy and Childhood , the recommended age for introduction of green vegetables in the edition was 36 mo, but that by the edition, the age had decreased to 9 mo.

However, it is evident that earlier introduction of beikost was common at least in some areas. Infants under the care of the Infant Welfare Society of Chicago between and received cereal at 5 mo of age and a vegetable at 6 mo of age Grulee et al.

Various developments in infant feeding and nutrition from — are indicated in Figure 2. Although data on the percentage of infants who were breast-fed in the United States from to are less satisfactory than later data, there is no question that the trend was downward.

The data of Bain regarding percentage of infants initially breast-fed are based on a review of discharge records and therefore are likely to be more accurate than the recall data of Hirschman and co-workers Hirschman and Hendershot , Hirschman and Butler Changes in infant feeding and nutrition from to breast feeding declined, whereas beikost and fresh cow's milk were introduced at earlier and earlier ages.

The first federal regulations concerning infant formulas went into effect in and, beginning in , commercially prepared formulas began to replace home-prepared formulas. Iron-fortified formulas were introduced in Exclusively and partially breast-fed infants as percentage of all infants in , and A smoothed curve is presented for based on data from personal communications from Boettcher, J.

From the s or early s, most formulas fed to infants in the United States were prepared by mixing evaporated milk or fresh cow's milk with water and adding carbohydrate. Home-prepared formulas were sometimes made with cow's milk usually pasteurized and homogenized rather than with evaporated milk. These formulas provided about the same distribution of energy from protein, fat and carbohydrate as did the evaporated milk formulas.

Most evaporated milk and most pasteurized, homogenized whole cow's milk were fortified with vitamin D. Orange juice was given as a source of vitamin C. Improved general sanitation, safe supplies of water and milk, and better understanding of both microbiology and nutrient requirements resulted in a high degree of success with formula feeding, and it was the opinion of most physicians and the general public that formula feeding was about as safe and satisfactory as breast-feeding.

However, the infant formulas in general use in the s were associated with a number of problems unappreciated by physicians and parents, including the following: 1 the high potential renal solute load placed the infants, especially young infants, at risk of developing hypernatremic dehydration during illness Fomon and Ziegler ; 2 the low content of iron in the formulas together with the high intake of inhibitors of iron absorption Fomon were responsible for a high prevalence of iron deficiency and, in the case of whole-milk formulas, probably with the added problem in some infants of increased intestinal blood loss Ziegler et al.

In addition, scurvy continued to be seen. A survey of teaching hospitals in the United States indicated that during the years —, infants and children were admitted to these hospitals because of scurvy Committee on Nutrition From the late s, a number of commercially prepared formulas were available in the form of powders that merely required the addition of water before being ready to feed to infants.

Many of these formulas had been developed in an attempt to mimic the chemical composition of human milk, and several researchers had focused their attention on the greater percentages of low-molecular-weight fatty acids in cow's milk than in human milk, believing that these were responsible for the poor tolerance of infants to butterfat Gerstenberger et al. Thus, even in the early s, formulas free of butterfat had been marketed. The cost of powdered formulas was appreciably greater than that of formulas made from evaporated milk or whole cow's milk, and usage of commercially prepared formulas was rather low.

By , concentrated liquid formulas had largely replaced powdered formulas Fig. The change from home-prepared formulas to commercially prepared formulas was accelerated by the introduction in of iron-fortified formulas and the vigorous promotion of these formulas by the formula industry and by pediatricians Andelman and Sered , Committee on Nutrition Percentage of 2- to 3-mo-old infants receiving various forms of feeding from to feeding of commercially prepared formulas prepared increased and feeding of formulas based on evaporated milk EM decreased.

Relatively few infants were breast-fed and few young infants were fed cow's milk CM. From at least the s Powers until the s, the protein concentration of human milk was believed to be greater than is now known to be the case, and many pediatricians believed that cow's milk protein was so inferior to human milk protein for meeting the needs of infants that infants fed formulas required a considerably greater intake of protein than did breast-fed infants.

Protein content of a number of widely used formulas ranged from 3. During the late s and early s, most of the leading commercially prepared formulas fell into one of two classes.

One class e. The gradual takeover of the market by the latter formulas seems not to have been based on considerations of nutrient requirements or renal solute load, but on the unpleasant odor of regurgitated butterfat after its partial digestion and on the impression that formulas similar to the home-prepared evaporated milk formulas led to constipation. As early as , James Gamble had gained at least some understanding of renal excretion of solutes Abt , but it was not until the s that the relation of renal solute load to water balance in infants received serious consideration Cooke et al.

However, even at the end of the century, infant formula regulations permitted the marketing of formulas with undesirably high potential renal solute load. However, most of the formulas fed in the first half of the 20th century exceeded this maximum and undoubtedly contributed to the prevalence of hypernatremic dehydration. An iron-fortified formula was introduced in the United States in ; by the mid s, most manufacturers offered the same base formula with or without substantial iron fortification Fomon Many parents and physicians were reluctant to use iron-fortified formulas because they believed that feeding such formulas was responsible for constipation, fussiness and intestinal disturbances in the infants.

Studies that failed to confirm such adverse effects Nelson et al. Nevertheless, the whey proteins of cow's milk are quite different from those of human milk; even today, rather meager evidence exists that a milk-based formula with added whey proteins results in a product that is superior to a milk-based formula without the additional whey proteins.

A formula based on soy flour was developed by Hill as a feeding for infants allergic to cow's milk and became commercially available in Abt Formulas prepared from soy flour were pale tan in color and had a nutty odor.

Parents complained that the formulas produced loose, somewhat malodorous stools, and resulted in staining of the reusable cloth diapers that were in general use. Excoriation of the diaper area was common.

The stool characteristics resulted primarily from the presence of considerable amounts of fiber in the soy flour. In addition to soy-based formulas, a meat-based formula and a casein hydrolysate formula were marketed. Several of these special formulas were not fortified with vitamins when initially marketed, apparently because pediatric allergists believed that the vitamin mixes used for vitamin fortification of formulas might include allergens.

In the s and s, a number of vitamin deficiencies were described Fomon In addition, goitrogens present in soy flour were responsible for development of goiters in infants fed a soy flour—based formula unfortified with iodine. A few cases of vitamin K deficiency were reported in the s in infants fed a meat-base infant formula protein from beef heart or a casein hydrolysate formula before these formulas were fortified with vitamin K Fomon Formulas prepared with isolated soy protein became commercially available in the United States in the mids and within 10 y almost completely replaced soy flour—based formulas.

Isolated soy protein—based formulas are similar in color to milk-based formulas and are nearly odorless. Because most of the fiber is removed during the protein isolation process, the infant's stools are generally similar to those of infants fed milk-based formulas. However, the process employed in isolation of the protein resulted in elimination of most of the vitamin K that had been naturally present in the soy flour—based products, and a few cases of vitamin K deficiency were reported before the products were fortified with vitamin K Fomon Development of nutrient deficiencies in infants fed milk-free formulas was responsible in part for the development of a series of federal regulatory actions on nutrient content of infant formulas.

The United States was among the last of the major industrialized countries to implement federal regulations concerning safety of infant formulas Miller It was not until that the new Food and Drug Act included reference to foods for special dietary purposes, including infant formulas.

In , the FDA declared that a food sold for use by infants should include a label declaration for moisture, energy, protein, fat, available carbohydrates, fiber, calcium, phosphorus, iron and vitamins A, B-1, C and D. In and , an alteration in the method of heat treatment of concentrated liquid SMA resulted in a decrease in vitamin B-6 content, and clinical manifestations of vitamin B-6 deficiency developed in a number of infants Fomon As a result of this experience, the FDA in published a proposed revision of the regulations.

A revised final regulation published in included the requirement for minimal levels of 11 vitamins and minerals; because of controversy over the regulations, however, it was not put into effect Miller The report of the Committee on Nutrition was used as a basis for public hearings in —, and the final regulation, published in FDA included minimum requirements for protein, fat, linoleic acid and 17 vitamins and minerals.

Throughout the first half of the 20th century, hospitals maintained formula laboratories to prepare formulas for newborns and other formula-fed infants. This activity required special equipment, was labor intensive and presented formidable problems in quality control. In the early s, commercial formula services began operating in a number of metropolitan areas in the United States Committee on Nutrition and many hospitals elected to use these services rather than to continue their own activities in formula preparation.

By the early s, considerable discussion centered about the cost effectiveness of purchasing ready-to-use formulas from outside sources rather than preparing them intramurally Fomon It was evident that use of a commercial formula service influenced the choice of stock formula selected by a hospital.

Manufacturers of various prepared formulas were therefore motivated to develop competing feeding systems. In , the Mead Johnson Company introduced the Beneflex system of feeding in which bulk quantities of any infant formula manufactured by that company could be transferred aseptically to feeders suitable to the needs of individual infants Fomon Soon afterward, the formula manufacturers were able to offer sterile ready-to-feed formulas in disposable bottles with disposable or reusable nipples.

These were first used in hospitals but were subsequently made available to the general public. An indication of the rapid rise in sales of ready-to-feed formulas during the late s and early s may be seen from Figure 5. The data in the figure apply to consumer sales and do not include hospital usage.

Early in , approximately equal numbers of hospitals in the United States used ready-to-feed formulas supplied by manufacturers and formulas supplied by locally operated commercial formula services. By , nearly all of the locally based commercial formula services had ceased to exist, few hospitals prepared their own formulas intramurally and most newborn nurseries used commercially prepared, ready-to-feed formulas.

The percentage may not have been quite as high for the entire country. Infants fed cow's milk no breast-feeding, no formula feeding as percentage of all infants in , and Data for and from Martinez et al. Because it was not yet appreciated that feeding of homogenized, pasteurized cow's milk to young infants could predispose to dehydration during illness and to development of iron deficiency, there seemed therefore little reason not to change at an early age from feeding formula to feeding fresh cow's milk.

Cow's milk was considerably less expensive than infant formula, required no mixing and was a staple item in the home. Still, more than years after Justus von Liebig sounded the death knell for wet nursing as a profession, perhaps the global supply chain could find a way to bring it back. Mothers criticise Baby Dove adverts.

Do mums really need breastfeeding help from technology? Why I breastfeed at work. Cambodia bans export of human breast milk. Why is Asia demanding so much baby formula? UK 'world's worst' at breastfeeding. BBC Future: Are there downsides to "breast is best"? Image source, Getty Images. Rigorous study. He invented something else, too: infant formula.

Justus von Liebig was inspired by the hunger he witnessed while a young man. What happened to those kids before formula? Good timing. Image source, Alamy. Earnings gap. Image source, AP.

Mark Zuckerberg is one of the few high-profile chief executives to take paternity leave. Researchers believe breastfeeding could help prevent more than , child deaths a year. Economic cost. But formula has another, less obvious economic cost. More from Tim Harford. Nestle controversy. Supply chain. Breast milk can be frozen and used at a later date. Related Topics. Published 3 July Published 6 June Published 11 May None of the antibodies found in breast milk are in manufactured formula.

So formula can't provide a baby with the added protection against infection and illness that breast milk does. Can't match the complexity of breast milk. Manufactured formulas have yet to duplicate the complexity of breast milk, which changes as the baby's needs change. Planning and organization. Unlike breast milk — which is always available, unlimited, and served at the right temperature — formula feeding your baby requires planning and organization to make sure that you have what you need when you need it.

Parents must buy formula and make sure it's always on hand to avoid late-night runs to the store. And it's important to always have the necessary supplies like bottles and nipples clean, easily accessible, and ready to go — otherwise, you will have a very hungry, very fussy baby to answer to. With feedings in a hour period, parents can quickly get overwhelmed if they're not prepared and organized.

Formula can be costly. Powdered formula is the least expensive, followed by concentrated, with ready-to-feed being the most expensive. And specialty formulas such as soy and hypoallergenic cost more — sometimes far more — than the basic formulas. Possibility of producing gas and constipation. Formula-fed babies may have more gas and firmer bowel movements than breastfed babies. Deciding how you will feed your baby can be a hard decision. You'll really only know the right choice for your family when your baby comes.

Many women decide on one method before the birth and then change their minds after their baby is born. And many women decide to breastfeed and supplement with formula because they find that is the best choice for their family and their lifestyle.

While you're weighing the pros and cons, talk to your doctor or lactation consultant. These health care providers can give you more information about your options and help you make the best decision for your family. Formula Feeding. Larger text size Large text size Regular text size. All About Breastfeeding Nursing can be a wonderful experience for both mother and baby. Here are some of the many benefits of breastfeeding: Fighting infections and other conditions.

This helps lower a baby's chances of getting many infections, including: ear infections diarrhea respiratory infections meningitis Breastfeeding also may protect babies against: allergies asthma diabetes obesity sudden infant death syndrome SIDS Breastfeeding is particularly beneficial for premature babies.

Common concerns of new moms, especially during the first few weeks and months, may include: Personal comfort. Here are other reasons women may choose to formula feed: Convenience. Making a Choice Deciding how you will feed your baby can be a hard decision.