# Frequently Asked Questions

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^{®}Milk-based Formulas: Whey Protein, Partial Hydrolysis and Benefits GERBER

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^{®}Soy-based Formula Starting with or Switching to a GERBER

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^{®}Formulas: Customizing Caloric Concentrations Probiotics, Prebiotics and Bifidobacteria: Breastmilk and GERBER

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### GERBER^{®} GOOD START^{®} milk-based formulas: whey protein, partial hydrolysis and benefits

What are the features and benefits of GERBER^{®} GOOD START^{®} Gentle formula?

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^{®}Gentle is a routine formula made with 100% whey protein partially hydrolyzed, and this composition has specific benefits due to the excellent biologic value of the whey protein. GOOD START

^{®}milk-based formulas are the first and only infant formulas made with 100% whey protein partially hydrolyzed. The whey protein is partially hydrolyzed to smaller peptide chains designed to be well tolerated in the developing infant gut, compared to the intact protein found in standard cow’s milk formulas. GERBER

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^{®}Gentle formula has prebiotics in the form of galacto-oligosaccharides, a prebiotic fiber sourced from milk, to support digestive health.

Is there any difference in stool appearance or frequency of an infant given GERBER^{®} GOOD START^{®} milk-based formula compared to other routine formulas?

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^{®}milk-based formula will resemble that of a breastfed infant; the stool color often will be green and the texture unformed. A more frequent stool pattern may also be observed as compared with the stool pattern seen with casein-predominant formulas. These changes in appearance and frequency are normal.

Are there any differences in gastric emptying time when feeding GERBER^{®} GOOD START^{®} formulas compared to casein-containing formulas?

What are partially hydrolyzed proteins?

What is meant by the term “Comfort Proteins”?

^{®}refers to 100% whey protein that is partially hydrolyzed. This patented two-step process breaks down the protein molecules into smaller peptide chains. In general, hydrolysis uses high temperatures or enzymes to modify protein molecules in formula into smaller units with lower molecular weight. COMFORT PROTEINS

^{®}are described as being easy to digest.

Is whey protein better than the protein source(s) used in other formulas? Why?

Whey protein is the highest quality protein source for use in infant formula. Formulas made with 100% whey protein have a faster gastric emptying rate – similar to breastmilk – than casein-predominant formulas. Delayed gastric emptying may contribute to gastroesophageal reflux. Also, formula high in whey protein promotes softer stools similar to that of a breastfed infant. For these reasons, GOOD START

^{®}milk-based formulas are designed to be made from 100% whey protein, and are casein-free.

**Billeaud** C et al. Gastric emptying in infants with or without gastro-oesophageal reflux according to the type of milk. *Eur J Clin Nutr* 1990;44(8):577–83.

**Fried** MD et al. Decrease in gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula. *J Pediatr *1992;120(4 Pt 1):569–72.

Since breastmilk contains both whey and casein, wouldn’t a formula containing both be closer to breastmilk?

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^{®}infant formulas to help better achieve the functionality of breastmilk, not to match the exact composition of breastmilk.

Who should use GERBER^{®} GOOD START^{®} 100% whey protein partially hydrolyzed formula?

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^{®}milk-based formula is an ideal routine formula for all healthy infants. When a mother is unable or chooses not to breastfeed, or chooses to supplement breastfeeding with formula, GOOD START

^{®}milk-based infant formulas may help reduce the risk of allergy in infancy and childhood that can result from exposure to intact cow’s milk protein. Also, the risk of common tolerance issues associated with the feeding of intact protein cow’s milk formulas may be reduced. GERBER

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^{®}formulas are not hypoallergenic and are not appropriate for infants with documented cow’s milk protein allergy.

**von Berg** A et al. for the German Infant Nutritional Intervention Study Group. Preventive effect of hydrolyzed infant formulas persists until age 6 years: Long-term results from the German Infant Nutritional Intervention Study. [GINI 6]. *J Allergy Clin Immunol* 2008;121(6):1442–7.

What are DHA and ARA? Does the enhancement of formulas with DHA and ARA have any positive effect on the infant?

ARA (arachidonic acid) is an omega-6 long chain polyunsaturated fatty acid (LCPUFA), also naturally found in breastmilk. ARA is a precursor of eicosanoids, which affect the regulation of immune, platelet and other vital bodily functions.

Some clinical studies have demonstrated that infants fed with formula supplemented with DHA and ARA have shown better cognitive development vs. infants fed with non-supplemented formulas. In addition, other clinical findings show that DHA and ARA may improve visual function and neurodevelopment in infants.

DHA and ARA are added to practically all infant formulas in the U.S., including GERBER

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^{®}formulas. However, currently there are no recommended levels of DHA and ARA set by the American Academy of Pediatrics (AAP).

Are GERBER^{®} GOOD START^{®} formulas hypoallergenic?

Vandenplas Y et al. The long-term effect of a partial whey hydrolysate formula on the prophylaxis of atopic disease. *Eur J Pediatr *1995;154(6):488–94.

According to the American Academy of Pediatrics (AAP) guidelines, published in 1990 and 2000 and revised by the policy posted on January 1, 2008:

*“The formula needs to be tested in infants with hypersensitivity to cow’s milk or cow’s milk-based formula and the findings verified by properly conducted elimination-challenge tests … Such formulas can be labeled hypoallergenic. Any formula with residual peptides may provoke reactions in infants allergic to cow’s milk. Extensively hydrolyzed proteins derived from cow’s milk, in which most of the nitrogen is in the form of free amino acids and peptides <1500 kDa, have been used in formulas for >50 years for infants with severe inflammatory bowel diseases or cow’s milk allergy. These formulas, as well as the newer free amino acid-based formulas, have been subjected to extensive clinical testing and meet the standard for hypoallergenicity.”*

Greer FR et al. and the Committee on Nutrition and Section on Allergy and Immunology. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. *Pediatrics* 2008;121:183–91.

Do GERBER^{®} GOOD START^{®} routine infant formulas contain the essential amino acid phenylalanine?

^{®}milk-based routine formulas have 460 mg of phenylalanine per prepared liter of formula. GOOD START

^{®}soy-based formulas have 850 mg of phenylalanine per prepared liter of formula. Levels in GOOD START

^{®}2 second stage formulas are slightly higher at 470 mg per prepared liter of milk-based formulas and 950 mg per prepared liter of soy-based formula.

What are the current fluoride recommendations for formula-fed infants? Do GERBER^{®} GOOD START^{®} formulas contain fluoride?

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^{®}formulas, ≤0.6 parts per million in milk- and soy-based formulas. Fluoride content will vary depending on the area of the country and source of water, and therefore will influence the fluoride content of any formula which is not ready-to-feed.

The National Academy of Sciences Institute of Medicine has specified safe tolerable upper daily intake levels for infants 0–6 months (0.7 mg/day) and 7–12 months (0.9 mg/day). For GERBER

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^{®}formulas, fluoride levels are as follows: powder formulas contain .04 mg/liter; concentrate formulas contain .09 mg/liter; and ready to feed formulas contain .1 mg/liter.

Are infants at risk for rickets? Is vitamin D supplementation important for formula-fed infants, breastfed infants, or both? Does GERBER^{®} GOOD START^{®} infant formula contain sufficient vitamin D?

All infant formulas sold in the U.S. are required to have at least 40 IU of vitamin D per 100 kcal. All GERBER GOOD START infant formulas have 60 IU of vitamin D per 100 kcal. One liter of prepared milk-based and soy-based GERBER

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^{®}infant formulas provides 400 IU of vitamin D, the daily level recommended by the AAP.

Wagner CL, Greer FR and the Section on Breastfeeding and Committee on Nutrition. Prevention of Rickets and Vitamin D Deficiency in Infants, Children and Adolescents.* Pediatrics* 2008;122(5):1142–52.

What is the difference between routine starter formulas and stage 2 formulas, such as GERBER^{®} GOOD START^{®} Gentle and GERBER^{®} GRADUATES^{®} Gentle formulas?

^{®}Gentle formula is a second stage formula, suitable for older infants and toddlers 9–24 months of age who are transitioning to solid foods. GRADUATES

^{®}Gentle formula has the same beneficial prebiotic glacto-oligosaccharides (GOS), as GOOD START

^{®}Gentle formula, and adequate calcium and iron to meet the needs of older infants and toddlers.

Are GERBER^{®} GOOD START^{®} formulas kosher?

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^{®}soy-based formulas are certified as kosher pareve by the Orthodox Union; liquid forms are certified as using kosher pareve ingredients manufactured on dairy equipment. GOOD START

^{®}soy-based formulas are also Halal.

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^{®}100% whey protein, partially hydrolyzed milk-based formulas do not meet strict kosher Orthodox Union guidelines due to processing ingredients used to hydrolyze the protein. Because the trypsin enzyme used in the hydrolysis process (to break down the protein to smaller molecules) is derived from a porcine source, these formulas are not classed as kosher. GOOD START

^{®}milk-based formulas are not Halal.

How do I compare the caloric value and basic nutrient information for the GERBER^{®} GOOD START^{®} infant formulas when evaluating key units of measure such as scoop, volume and weight measures?

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^{®}infant formulas across a wide range of unit measures. A pdf of the

**Routine Infant Formulas Nutrient Comparison Chart**can be accessed at the following link:

Routine Infant Formulas Nutrient Comparison Chart. Always check the label for the most up to date nutrient information.

### GERBER^{®} GOOD START^{®} soy-based formula

Which infants would benefit from a GERBER^{®} GOOD START^{®} soy-based formula?

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^{®}Soy formula is the only routine formula available with partially hydrolyzed soy formula. GOOD START

^{®}Soy formula has been certified as kosher pareve by the Orthodox Union, and are also Halal.

### Starting with or switching to a GERBER^{®} GOOD START^{®} formula

Which infants would benefit from a GERBER^{®} GOOD START^{®} soy-based formula?

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^{®}Soy formula is the only routine formula available with partially hydrolyzed soy formula. GOOD START® Soy formula has been certified as kosher pareve by the Orthodox Union, and is also Halal.

How rapidly should an infant transition to GERBER^{®} GOOD START^{®} formula from another routine formula?

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^{®}formula over about a week. If there is any increase in fussiness on a particular day, the same number of bottles of current formula and GOOD START

^{®}formula can be maintained for another day.

The timing depends on the number of bottles currently being fed. The following schedule is recommended for transitioning to GERBER

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^{®}formula over a 7 day period, feeding a total of 6 bottles per day:

What differences may be noticed in the infant when switching to a GERBER^{®} GOOD START^{®} milk-based formula from another routine milk-based formula?

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^{®}milk-based formula, there may be some noticeable changes in the infant’s feeding and stool patterns.

There may be less spitting up: casein-predominant formulas may form curds in the infant’s stomach which may take longer to digest. GERBER

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^{®}milk-based formulas are made from 100% whey protein and do not form curds. 100% whey protein formulas empty from the stomach faster than casein-predominant formulas, at about the same rate as breastmilk.

The infant may drink a little less per feeding of a GERBER

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^{®}milk-based formula, but feed more frequently over the course of the day – so that the same total number of ounces will still be consumed. For example, the infant may feed every 3 hours with a GERBER

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^{®}milk-based formula as compared with every 4 hours with another routine formula. More frequent feeding is associated with the faster gastric emptying time of a GERBER

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^{®}milk-based formula, similar to that of breastmilk.

A change may be noticed in the infant’s stools. They may be soft, unformed and yellow to dark green in color, like the stools of breastfed babies. The frequency of stools may also resemble that of a breastfed baby.

The light color of a GERBER

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^{®}milk-based formula is similar to the color of breastmilk. If a bottle of a GERBER

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^{®}milk-based formula is prepared and refrigerated, it may separate into layers like breastmilk does. Shaking the bottle will re-mix the formula.

### GERBER^{®} GOOD START^{®} formulas: customizing caloric concentrations

Does Nestlé have suggested “recipes” to use with GERBER^{®} GOOD START^{®} Premature 24 formula in order to either dilute or concentrate the formula?

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^{®}Premature 24 formula has 24 calories per ounce. The dilution/concentration instructions and resulting nutrients are provided for medical professionals only, and are available at the link below. Nestlé does not recommend the extended use of diluted formulas for premature infants, unless there is a specific clinical indication and the infant is under the close supervision of a healthcare professional.

GERBER® GOOD START® Premature 24 Calorie Modified Recipes and Resulting Nutrient Profiles

Can I create higher caloric concentrations of GERBER^{®} GOOD START^{®} infant formulas?

Increasing Caloric Density of GERBER® GOOD START® Infant Formulas

### Probiotics, prebiotics and bifidobacteria: breastmilk and GERBER^{®} GOOD START^{®} formulas

Are bifidobacteria present normally in breastfed infants?

Gueimonde M, Laitinen K, Salminen S, Isolauri E. Breast milk: a source of bifidobacteria for infant gut development and maturation? *Neonatology* 2007;92:64-6.

Yoshioka H, Iseki K, Fujita K. Development and differences of intestinal flora in the neonatal period in breast-fed and bottle-fed infants. *Pediatrics* 1983;72:317–21.

Fooks LJ, Gibson GR. Probiotics as modulators of the gut flora. *Br J Nutr* 2002;88(Suppl 1):S39–S49.

What is the difference between probiotics and prebiotics?

Prebiotics are non-digestible carbohydrates that stimulate the growth of beneficial bacteria, such as bifidobacteria and lactobacilli, in the gut. Prebiotic fiber reaches the colon completely intact, where it provides a food source for probiotic bacteria. By supporting the growth and maintenance of a healthy microbiota (also known as microflora), prebiotics potentially help support the immune system. Prebiotics may also contribute to healthy bowel function and promote mineral absorption.

Why is *Bifidobacterium lactis* the strain of probiotic bifidobacteria chosen for inclusion in GERBER^{®} GOOD START^{®} Gentle for Supplementing?

*B. lactis*for consumption by infant populations is well documented and there is support from many clinical studies that this particular strain can provide benefits to healthy infants, which is the reason why it has been chosen for inclusion in routine formula.

**Gueimonde** M, Laitinen K, Salminen S, Isolauri E. Breast milk: a source of bifidobacteria for infant gut development and maturation? *Neonatology* 2007;92:64-6.

**Yoshioka** H, Iseki K, Fujita K. Development and differences of intestinal flora in the neonatal period in breast-fed and bottle-fed infants. *Pediatrics* 1983;72:317–21.

Is GERBER^{®} GOOD START^{®} Gentle for Supplementing formula the only infant formula with *Bifidobacterium lactis*?

^{®}Gentle for Supplementing formula is the first routine infant formula in the U.S. to contain the probiotic bacteria strain Bifidobacterium lactis (B. lactis), similar to probiotics found naturally in breastmilk.

How is a probiotic kept alive in a formula?

*Bifidobacterium lactis*– the probiotic cultures added to GOOD START

^{®}Gentle for Supplementing formula – are “inactive.” Only when water is added do the probiotic bacteria become active – capable of reproducing and interacting within the infant’s digestive system to provide protective benefits. While it is always recommended that water not exceed 100°F when mixing with powdered formula, this is especially important with GOOD START

^{®}Gentle for Supplementing to ensure that the viability of the probiotic cultures is preserved.

Will the immune-related benefits of GERBER^{®} GOOD START^{®} Gentle for Supplementing formula end if this formula is stopped or another formula is added to the feeding schedule?

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^{®}Gentle for Supplementing formula will remain in the digestive tract for several days after the consumption of probiotics stops. All consumed probiotic cultures only temporarily colonize the digestive tract and need to be consumed on a regular basis to maintain a healthy balance of bacteria – along with their related health benefits. If GERBER

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^{®}Gentle for Supplementing formula is alternated with another formula that does not have probiotics, no problems or adverse events would be expected.

Are there any contraindications for GERBER^{®} GOOD START^{®} Gentle for Supplementing formula?

Does GERBER^{®} GOOD START^{®} Gentle for Supplementing formula taste different?

*B. lactis*probiotic cultures does not change the taste of GOOD START

^{®}Gentle for Supplementing formula as compared with other Gerber milk-based infant formulas that have 100% whey protein partially hydrolyzed and DHA & ARA.