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Breaking down what’s available and when you might need it

When parents need or choose formula, I’m frequently asked what I would recommend. While I don’t have a specific brand that I recommend, I usually start with standard cow’s milk formula. Most babies don’t need special formulas and there is so much out there that it’s overwhelming and frequently confusing. Yet there may be times when different formulas are needed, so I will attempt to provide an outline of what you might see on the shelves and what it means. Disclaimer: This guide will be for full term babies only and I will not talk about formulas needed for special medical conditions.

Before we dive into the different types of formulas, I need to make a few points.

  • Baby formula is highly regulated by the FDA for safety and for nutritional content. Importing formula is actually illegal, and there is not guarantee about the processing, storing, handling and sterility of the product.
  • Baby formula should always be mixed according to the can to avoid changing the calories or nutrition of the milk, unless directed by your doctor.
  • Babies do not need different formulas at different ages and they don’t need toddler formula after age 1.
  • Babies should not be given low iron formula.
  • Do not add cereal to your babies bottle without instruction from your pediatrician. (I typically do not make this recommendation.)
  • Making your own formula is not considered safe and can result in serious nutritional deficiencies.
  • Formula companies make a lot of unsubstantiated claims and make a lot of different, but often unnecessary, types of formulas, often times so they can charge more. Read this guide before choosing a brand.
  • You will pay more if you choose organic or non-GMO formula.
  • Thriving breastfed babies don’t need formula for any other reason than parental choice, even if the package says the formula is specifically for breastfed babies.

What are the different ways formula is sold?

Formula comes in 3 different forms and the one you choose will be based on you and your baby’s preference. There isn’t a nutritional or caloric difference.

Powder: This formula comes in a can and needs to be mixed with water. It’s important to mix exactly according to instructions. The benefit is you can buy a large can and it can last several days.

Liquid Concentrate: This formula also needs to be mixed but has to be refrigerated and only stays fresh up to 48 hours.

Ready to Feed: This formula is packaged in small bottles and does not require mixing. Just add the nipple on top and it’s ready to go.

What types of formula are available?

A sample of some majorly formula companies and their products. Not and exhaustive list of what is available.

A sample of some majorly formula companies and their products. Not and exhaustive list of what is available.

Standard cow’s milk based formula is the most common formula used and is available from multiple brands, as well as in generic versions at many stores. They are all essentially the same and due to strict oversight, will have the same ingredients (with some variation like types of sugars used) and nutrition. The cow’s milk proteins are treated to make them safe and easy to digest. They will all have iron, and many will have prebiotics or probiotics to help colonize the baby’s GI tract with healthy flora. Furthermore, most will also have healthy fats found in breastmilk called AHA and DRA. These are felt to help brain and eye development.

Hydrolyzed formulas are made with proteins that are either partially broken down or fully broken down. This is meant to ease digestion. You may find partially hydrolyzed proteins in formulas labeled as “gentle”. Some studies suggest that these formulas can reduce the risk of developing allergic conditions, like eczema, in babies who are already at high risk of developing them. The fully hydrolyzed formulas are meant for babies with an allergy to standard cow’s milk formula. The proteins are still cow milk based but they are broken down enough to be safe for use in most babies with milk protein allergy. However it is very costly and doesn’t smell or taste great, so it’s not a good first line formula.

Amino acid based formula is similar to fully hydrolyzed formula but the proteins are not cow milk based. Therefore, for severely allergic babies who do not tolerate fully hydrolyzed formulas, this is the option to use.

Soy formula is almost never recommended. It is necessary for babies with galactosemia and helpful for families who are vegetarian and do not wish to use cow’s milk based formula. The protein is large so it’s not as easy to digest. Some parents like it because it doesn’t use lactose for the sugar, but most babies do not require lactose-free formula (see below). Furthermore, many babies with cow milk protein allergy also have soy allergy, so if your baby is allergic to cow milk it is best to use a fully hydrolyzed (hypoallergenic) formula.

Lactose free formulas are available and can be helpful for babies who are temporarily lactose intolerant due to diarrhea. However, true lactose intolerance, or lactase deficiency, in infants is extremely rare. Babies rely on lactose as their primary carbohydrate, or energy source, and it is the main sugar in breastmilk. Therefore, giving your baby lactose free formula may not fix a fussiness or gassiness problem. (While researching this article I found that Similac Sensitive is not for use in babies with galactosemia or lactase deficiency, meaning it likely has some lactose in it.)

Added rice starch in formula can be helpful for babies with acid reflux. It is safer to use an AR formula that to add cereal directly to your baby’s bottle.

As you can see, the formula industry has made buying baby formula expensive and complicated. If you have any questions about which type of formula to use, ask your pediatrician. Overall, for the majority of full term healthy infants, generic cow milk formula is perfectly acceptable.

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