Milk feeding in the First Year of Life

If an infant is not or not exclusively breastfed - for whichever reason - there is consensus that a formula milk (FM) should be given. Human milk serves as a reference for the development of industrially produced FM. The composition is regulated by law at the European level.² The legislator differentiates between two stages of formula milks.

1. Infant Formulas – can be used from birth onwards for exclusive feeding of the infant. They are usually labeled „Pre“ or „1“. Whereas Pre-stage formulas solely contain lactose as a carbohydrate, stage 1 formulas may also contain up to 2g/100 ml of easily digestible starch.² This makes the formula creamier and, even for a young infant, easily digestible.
2. Follow-on Formulas – these are suitable in combination of complementary foods from the 6th month (stage 2 formulas) or – depending on country-specific assortment - from the 11th month (stage 3 formulas) as part of a mixed diet. Follow-on formula is optimally adapted to the needs of older infants. This particularly is the case for minerals such as iron and calcium, their content lies markedly above the infant formula ones. Furthermore, they have an adapted casein-whey ratio, which promotes improved satiety. Follow-on formula often contains starch, but there are also starch-free products on the market. The energy and protein content of infant and follow-on formulas differ only slightly.

In addition to the compulsory ingredients, many FM contain optional functional ingredients such as the long-chain polyunsaturated fatty acid (LCP) arachidonic acid. The addition of omega-3 fatty acid docosahexaenoic acid is legally required for both infant and follow-on formulas. The addition of these LCPs is recommended by scientists because they support cognitive development and visual functions.³

The enrichment with pre- and probiotics, some of which are also found in human milk, is optional. The combination of pre- and probiotics is called synbiotic and serves to support the gut microbiota. A balanced gut microbiota supports the still immature immune system of the infant.

HiPP COMBIOTIC^® contains the unique combination of valuable dietary fibres galacto-oligosaccharides (GOS) and the probiotic L. fermentum, originally isolated from human milk. This combination has already been studied in clinical trials, proving its benefits and long-term safety. Recent study results show a significant reduction in lower respiratory tract infections due to the synbiotic effect and its positive effects on the gut immune system and the gut-lung axis.⁴

In addition to FM based on cow‘s milk, those based on other animal milks or plant-based raw materials are also offered.⁵ The use of pure cow‘s milk as a beverage should be avoided in the first year of life, if possible, as its high protein and mineral content strains the infant’s still immature kidneys. FM based on goat‘s milk protein are not suitable for the prevention of cow‘s milk protein allergy (CMPA) due to similar protein composition and should not be given in the presence of CMPA due to cross-reactivity. For infants at increased risk of allergies who are not or not exclusively breastfed, it should be checked until the introduction of complementary foods whether an infant formula with clinically proven efficacy for allergy prevention is available. Hydrolysed infant formulas remain an option.^6,7

References:
¹ Abou-Dakn et al. Monatsschr Kinderheilkd 2025; 173 (Suppl 1): 69–93.
² VO (EU) 2016/127, konsolidierte Fassung vom 11.10.2024.
³ Bührer et al. Monatsschr Kinderheilkd 2020; 168: 536–540.
⁴ Piloquet et al. Am J Clin Nutr 2024; 119 (5): 1259–1269.
⁵ ÖGKJ, DGKJ, SGP et al. Monatsschr Kinderheilkd 2023; 171: 822–828.
⁶ Halken et al. Pediatr Allergy Immunol. 2021; 32: 843–858.
⁷ ÖGKJ, DGKJ & Haiden. Monatsschr Kinderheilkd 2023; 171: 545–550.

Important information: Breastfeeding is best for babies. Infant formula should only be given upon the advice of paediatricians, midwives or other independent experts.