Painful Math – Deciphering Infant Formula Recipes

Just a few weeks ago, something happened at work, and I couldn’t believe the timing —a story I’ve seen far too many times. Although I’ve changed the details to protect privacy, the heart of it remains the same. If you’ve worked with infants, chances are you’ve encountered—or will encounter—a family that is improperly mixing formula. Here it goes, …

A 2-month-old was admitted in my unit with increased work of breathing. He was dehydrated. His weight had been faltering in the past month, with a plateau in the past two weeks.

I met with the mother at bedside to complete my nutritional assessment. He was bottle fed a standard infant formula, taking about 60 mL every 3-4 hours and had started to experience some spit ups and vomiting in the past two weeks. Mother was instructed to concentrate feeds to 24 kcal/oz at his community follow up two weeks ago to help with weight gain.

After many clarifying questions, we confirmed her recipe was ½ scoop (the one in the can) of a standard infant formula powder added to 60 mL (2 oz) of the same brand ready-to-feed standard infant formula.

Recipe: 1/2 scoop powder + 60 mL ready-to-feed

This is not a standard recipe, so I worked my way through the painful math of deciphering the concentration that was being prepared.

First Step: Confirm the recipe

Key questions to ask families to help clarify recipes that are not standard:

• Where did you obtain the recipe?
• Do you still have the handout or instructions?
• How long have you been following this recipe?
• How is this recipe tolerated?
• Are you using the scoop inside the can?
• Are you using a household tool such a teaspoon or tablespoon?
• Is it a baking spoon? Or a random spoon in your drawer?
• How are you filling your tool?

Second Step: Gather information

This information can be found on the can, or on the manufacturer website. It can vary from product to product.

Third Step: The dreaded math

Fourth Step: Is the recipe correct?

The mother had been given a handout that had confusing instructions, and unfortunately was using the wrong measuring tool, inadvertently preparing 30 kcal/oz instead of a 24 kcal/oz recipe.

What are the risks of improper mixing?

Over concentration:

Can lead to poor tolerance, dehydration and/or kidney strain

Under concentration:

Can result in poor growth, nutrient deficiencies and electrolyte abnormalities

Taking the time to understand how recipes are being prepared, and what concentration they provide can help us understand symptoms and create better nutrition interventions.

What are we up to right now at Nutrition Masterclass:

 Check your inbox next week! We’ll be sending you hot deals on all our course offerings for Black Friday.

 Do you struggle with dietitian math? Didn’t learn how to calculate recipes at school or during your internship? Do you find yourself overwhelmed with how to decipher caregiver recipes that aren’t standard? We get it! We’re in the process of creating an infant formula math workshop to take the pain out of dietitian math. Stay tuned for more details!

As always, we’d love to hear your thoughts. Have you had a similar experience?

Charlene and Julie

P.S. Our Black Friday Sale is just around the corner! Check your inbox next week for your special discount codes!