Powdered Infant Formula Milk (PIF) – Perceptions and Facts

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We have learnt during our school days to solve problems in mathematics or physics or chemistry by applying the right formula.  Yes, the right formula aptly applied, solved several problems.  The same formula applied on to a wrongly perceived problem would land us in trouble. 

The same thing holds good in infant feeding.  

Nature’s way of nurturing the newborn or younger children is by providing customized breast milk.  The “customized,” needs to be emphasized here, which means, the breast milk is not only species specific, but also baby specific.  Breast milk is secreted according to the situation of the baby.  For example, a baby born premature needs a different composition milk, which is taken care of at zero cost.  Composition of breast milk is so unique that the initial part helps in quenching the thirst of the baby whereas the later part provides necessary energy and nutrition, thereby providing a full package with no additional need for water.  Breast Milk is the best gift any mother could give to her child. 

There are only a few problems where the formula (Powdered Infant Formula – PIF) is indicated viz., certain metabolic disorders, some of the maternal infections, genuine lactational failure etc.  Here too, formula aptly applied can solve the feeding issue. Thanks to powdered infant formula milk in such cases. For wrongly perceived problems, the same formula may pave way for several issues.

In simple terms, Powdered Infant Formula or PIFs are humanized cows’ milk, manufactured as close as possible to match the human milk.  There are specialized PIFs viz., soya-based formula, extensively hydrolyzed formula, amino acid-based formula, thickened PIFs, lactose-free formula feeds for certain situations like metabolic disorders, cow’s milk protein allergy, regurgitation or lactose intolerance and so on.  Formula feeds are also available as RTF (Ready to Feed) bottled milk.

Let us look into certain perceptions where in the formula is wrongly applied and understand the facts which would help in avoiding that.

Perceptions and Facts:

  1. Perception:  Especially the first time mothers would walk in saying “not enough breast milk.  Can I give formula feeds or any other breast milk substitute?”

Fact:  If the baby feeds around 8-12 times per day for about 20-40 min; gulping sound while on breast; gaining adequate weight, sleeping well, stooling 3-5 times or after each feed and voiding clear or pale yellow urine 6-8 times would indicate adequate lactation. Most of the time, proper counselling would solve this issue of “not enough breastmilk!”

  1. Perception:  “My baby is losing weight.  Should I start top feeds?”

Fact: Almost all breastfed babies lose weight during the first week of life (upto 10% of birth weight) and regain birth weight by the end of the second week.

  1. Perception: “My baby is passing stools once in 3-4 days.  I think the milk is very less?”

Fact: Adequately breastfed babies may pass 3-4 or more stools/day or once in 3-4 days.  As far as the weight gain and urine output are good, nothing to worry even if stooling is delayed up to 7 days.

  1. Perception: “Baby is crying always.  My parents are saying to give some bottle feeds.  Should I?”

Fact: Only language the baby knows during initial months is “cry.”  Look for the other causes like wet diapers, abdominal discomfort, insect bite, some injury etc., before concluding on inadequate breast milk.

  1. Perception: “He keeps sucking at his fingers or the moment we put our finger.  I guess he is hungry in spite of frequent feeding?”

Fact: Sucking is a natural reflex.  Even when fully fed or while asleep, the baby sucks at the finger or pacifier.  That doesn’t always indicate hunger. 

  1. Perception: “My sister’s baby is quite chubby and my baby is tiny.  Both were born on the same day.  Can I start formula feeds?”

Fact: Each baby is different and their rate of weight gain too.  If the weight gain is within the normal limits (as indicated by the growth curve chart), no need to worry.

  1. Perception: “My friend says that at least 2-3 bottle feeds (PIF) would help in gaining weight faster.”

Fact:  Faster weight gain doesn’t always mean healthy.  

  1. Perception: “I need to go to work from next month.  Should I start formula feeds from now itself so that the baby will get used to it?”

Fact: Breast milk is the best at any given point of time during the first two years of life during which time the maximum brain growth happens.  If direct breastfeeding is not possible, the next option would be to feed the expressed breast milk (which can be kept at room temperature for 4-6 hrs and in the refrigerator up to 72 hrs.)  

  1. Perception: “Breastfeeding is more stressful.  Bottle feeding is more comfortable, easy and I can know how much my baby is taking. I can also make sure that my baby takes the exact recommended amount of milk every time.  Please suggest which formula is the best?”

Fact: I understand your concerns.  But, everything comes with a cost.  The bottle feeding can cause dental and palatal abnormalities over time.  It can also make the infant prone for ear infections.  Most of the formula feeds cause constipation.  The cost of each tin or packet of formula feed adds on to the financial burden.  Moreover, the preparation error while adding water may lead to more diluted feeds thereby less calorie and protein intake.  Contamination is another issue, which can lead to respiratory and gastrointestinal infections.  Though formula feeds are prepared to closely match human milk, still it lacks certain unique features of breast milk such as immune boosting, gut priming, protection towards asthma and allergies in later years etc.,

  1. Perception: “By giving formula feeds, I can take breaks and be free as anyone else can feed the baby.  I can afford the best formula in the market.  Please suggest?”

Fact:  Motherhood is a unique gift by nature. You can take breaks even while breastfeeding by expressing and storing the milk.  One of the biggest advantages of breastfeeding is the development of bonding between you and your baby which may not happen with formula feeds.  

  1. Perception:  Encountered mostly with first time mothers.  “I’ve tried my best to exclusively breastfeed.  Maybe I’m having lactational failure.  Shall I start formula feeds?”

Fact: Many a time the lactational failure is not genuine.  Simple corrections like proper positioning, rectifying nipple issues (painful or cracked nipples due to improper feeding techniques) with the help of trained lactational consultants would solve this.  These retracted or flat nipple issues could have been taken care of during pregnancy itself.

Approximate price range for Powdered Infant Formula milk (Regular milk powder stage 1)

PIF milk brand Indian Market (400 gm/tin) US Market (12.7oz/tin)
Brand A  Rs. 350  USD 7
Brand B Rs. 750 USD 15
Cost comparative table

Average number of tins (400 gm or 12.7oz) consumed by a baby per month may range from 4-5 tins in 1st month (Rs. 1,750 – 3,750 or USD 35 – 75) to 10-12 tins by 6th month (Rs. 3,500 – 7,500  or USD 85 – 180).  Note:  Cost of specialized formula and maintenance (bottles/accessories/containers/spoons/sterilizers etc.,) are not mentioned. 

“If your only tool is a hammer, then every problem looks like a nail (Abraham Maslow)” whereas “a problem well stated is a problem half solved (John Dewey).”

Also Read Antibiotics – Diligent Restrained Use For A Secure Tomorrow Part – 1 and Part – 2


Practicing Pediatrician and Neonatologist. Originally hailing from Mysuru, he is practicing in Kuwait since 10 years.

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