For certain rare genetic diseases such as galactosemia,¹ (identified through the early newborn metabolic screening)² non-milk-based human milk substitutes are the suggested feeding option.

For galactosemia, because the lactose in human milk and dairy-based formulas cause life-threatening symptoms in newborns, newborns must be given soy-based or elemental formulas, even when parents are still waiting for a confirmation of a diagnosis after an abnormal result from initial newborn screening.

Reasons for infants to require specialized formula instead of human milk:³

• Infants with classic galactosemia: a special galactose-free formula is needed.
• Infants with maple syrup urine disease: a special formula free of leucine, isoleucine, and valine is needed.
• Infants with phenylketonuria: a special phenylalanine-free formula is needed (some breastfeeding is possible, under careful monitoring).

There are medical reasons pertaining to the health of the lactating parent to not breastfeed as well.⁴

Next: Risks and ethics of human milk substitutes

_______________

1. CDC – The Galactosemias ↩︎
2. Commonly referred to as the heel prick or PKU test but it is an extensive panel. Health Resources & Services Administration – Recommended Uniform Screening Panel ↩︎
3. The Codex Alimentarius sets guidelines on formulated complementary foods for infants 6-12 months and young children 12-36 months. Codex Alimentarius. 2017. Guidelines on Formulated Complementary Foods for Older Infants and Young Children ↩︎
4. WHO – Acceptable medical reasons for use of breast-milk substitutes ↩︎