By Lindsay Lock, MS, RD
For healthcare providers, understanding the intricacies of infant nutrition is important. While infant formula serves as a vital source of nutrition for those not breastfed, altering its concentration—either by diluting or concentrating it—can affect an infant's health. This post delves into the reasons behind formula alteration, the associated risks, and importance of adhering to proper formula preparation guidelines.
Why You Should Never Dilute Formula
Dilution occurs when excess water is added to powder to reduce the caloric concentration below the standard 20 calories per ounce. This reduces not only the caloric content but also essential nutrients, risking malnutrition and developmental delays. Healthcare providers play a critical role in educating caregivers on the importance of adhering to formula preparation guidelines to prevent such nutritional deficiencies. Different formula brands and types can have varying mixing instructions and scoop sizes. It is important for healthcare professionals to note the differences between formula mixing instructions for different brands to ensure caregivers are following the intended recipe.
Health Concerns Associated with Diluting Formula
The dilution of formula can lead to inadequate intake of key vitamins and minerals, resulting in nutritional deficiencies with long-term growth and developmental implications. Altering the formula concentrations so that there is an excess of water, may lead to disruptions in the balance of calcium, potassium, and sodium potentially leading to seizures.1
Reasons to Concentrate Formula
In certain medical instances, concentrating infant formula above the standard 20 calories per ounce may be considered under professional guidance to increase caloric intake for infants requiring weight gain or having increased energy needs. This includes situations where an infant is underweight, experiencing growth delays, or has specific health conditions that increase their caloric requirements. It's vital for healthcare providers to educate their families appropriately on concentrating formulas due to the potential risks involved.
The Risks of Concentrating Formula
Concentrating infant formula to a certain degree can lead to hyperosmolar feeds, potentially leading osmotic diarrhea because of elevated osmolality beyond the standard <400 mOsm/kg cite. 2 Although concentrating infant formula is often used in aiding in the growth and development of certain infants, the practice should always be used under medical supervision. When concentrating formula, it is important to ensure the recipe used is yielding the intended caloric concentration and osmolarity. Additionally, monitoring the infants tolerance, fluid status, and electrolyte balance is crucial to ensuring safety when concentrating feeds.
Conclusion
While there may be specific medical instances where altering formula concentration is considered, it is imperative for healthcare providers to guide and educate caregivers on the proper formula mixing instructions intended for the health and safety of their infant. It is important to note that adjustments in formula mixing are made with careful consideration and monitoring. Following the recommended guidelines for formula preparation is crucial to providing infants with the nutrition they need for healthy growth and development.
References
- Houck J, Ganti L, Vera AE. A Case of Hyponatremia-induced Seizures in an Infant Secondary to Water Intoxication from the Use of Almond Milk. Cureus. 2019 Oct 13;11(10):e5899. doi: 10.7759/cureus.5899. PMID: 31763101; PMCID: PMC6850747.
- Steele JR, Meskell RJ, Foy J, Garner AE. Determining the osmolality of over-concentrated and supplemented infant formulas. J Hum Nutr Diet. 2013 Feb;26(1):32-7. doi: 10.1111/j.1365-277X.2012.01286.x. Epub 2012 Dec 4. PMID: 23210913.
