Pediatric Nutrition in Practice

102 Koletzko^

6th month on and for young children [16]. The
concept of follow-up formula offers the potential
to adapt the product composition to the changing
needs with increasing age, e.g. by increasing iron
and decreasing protein contents. The current Co-
dex standard for follow-up formula was adopted
in 1987 and does not reflect current scientific
knowledge. Therefore, an international expert
group recently reviewed the available evidence
from studies addressing the specific nutrient
needs of infants aged 6–12 months and provided
recommendations on the composition require-
ments of follow-up formulas for older infants [17]
( table 2 ).

Follow-Up Formula for Young Children

While follow-up formula for infants may be fed
after the age of 1 year without harm, special for-
mula products for young children aged 1–3 years
have been widely marketed. Such products are
not necessary to meet the nutritional needs of
young children who receive a balanced, quality
diet. However, many young children have a less
than satisfactory intake of critical nutrients such
as iron, iodine, vitamin D, α-linolenic acid and
DHA [7]. Nutrient-enriched follow-up formulae
for young children that serve as a substitute for
cow’s milk may help to improve nutrient supply
but should be composed in such a way that they
are not inferior to cow’s milk, e.g. provide at least
a similar supply of calcium and avoid a high con-

tent of sugars and flavouring that may interfere

with the desirable development of taste prefer-

ences [18].

Conclusions

• Infant formulae serve as substitutes for breast-
  feeding and must meet very high quality and
  safety standards


• The composition of infant formula should fol-
  low current science-based recommendations


• Special infant formulae such as soy protein-
  based and thickened formulae should be used
  according to specific indications


• Some formulae based on protein hydrolysates
  were shown to reduce the long-term risk of
  food allergy and atopic dermatitis and are rec-
  ommended during the first 4–6 months of life
  in infants with a family history of allergy who
  are not fully breastfed


• Follow-up formulae for infants offer the po-
  tential to provide an age-adapted nutrient
  content, e.g. a higher iron and a lower protein
  concentration


• Follow-up formulae for young children aged
  1–3 years are not necessary to meet the nutri-
  tional needs of young children who receive a
  balanced, quality diet, but they may contribute
  to improving the supply of critical nutrients. If
  used, they should not be inferior in their com-
  position to cow’s milk, while a high content of
  sugars and flavouring should be avoided

References 1 ESPGHAN Committee on Nutrition;

Agostoni C, Braegger C, Decsi T,

Kolacek S, Koletzko B, Michaelsen KF,

Mihatsch W, Moreno LA, Puntis J,

Shamir R, Szajewska H, Turck D, van

Goudoever J: Breast-feeding: a commen-

tary by the ESPGHAN Committee on

Nutrition. J Pediatr Gastroenterol Nutr

2009; 49: 112–125.

2 WHO: Global strategy for infant and

young child feeding. Geneva, WHO, 2003.

3 Koletzko B, Baker S, Cleghorn G, Neto

UF, Gopalan S, Hernell O, Hock QS,

Jirapinyo P, Lonnerdal B, Pencharz P,

Pzyrembel H, Ramirez-Mayans J,

Shamir R, Turck D, Yamashiro Y, Zong-

Yi D: Global standard for the composi-

tion of infant formula: recommenda-

tions of an ESPGHAN coordinated

international expert group. J Pediatr

Gastroenterol Nutr 2005; 41: 584–599.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 97–103

DOI: 10.1159/000375271