Guide on How to Choose a Baby Formula 2023

The infant formula aisle can be an overwhelming place. With so many choices, how do you know which formula is right for your baby? Our guide can help you make sense of the options.

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You may also want to consult with your baby's doctor. She can offer guidance on the best formula for your baby and your family's lifestyle. Other things to consider when choosing formula: the form it comes in, the type of protein and carbohydrate it provides, and any additional ingredients that are included.

What are the different forms of formula?

Formulas come in three forms: ready-to-use, liquid concentrate, and powdered.

Ready-to-use formula

This is definitely the most convenient formula type – no mixing or measuring required. Just open and serve. It's the kind of formula that hospitals often give to newborns. It's hygienic and especially helpful when you don't know whether you'll have access to safe water.

The convenience of ready-to-use formula comes at a price – it costs about 20 percent more per ounce than powdered formula. The containers also take up more storage space in your cupboard and more space in the landfill (unless you can recycle the containers).

Once opened, ready-to-use formula has a short lifespan – it must be used within 48 hours. Also, because liquid formula is often darker than powdered formula, many moms complain that it's more likely to stain clothes.

Liquid concentrate formula

This type requires mixing equal parts of water and formula concentrate. Compared to ready-to-use formula, concentrate is less expensive and takes up less storage space. Compared to powdered formula, it's a little easier to prepare but more expensive.

Powdered formula

As the most economical and the most environmentally friendly formula option, powdered formula takes up the least amount of space in transport, in your pantry, and in your trash can.
Powdered formula takes more time to prepare than other types of formula, and you must follow the directions exactly, but it has a one-month shelf life after the container has been opened. As with liquid concentrate formula, you can mix up just the right amount – as much or as little as you want – whenever you need it. This is especially helpful if you're a breastfeeding mom who may only need a supplemental bottle occasionally

What are the different types of formula?

Cow's-milk-based formula

Most formula available today has cow's milk as the main ingredient. The overwhelming majority of formula-fed and formula-supplemented babies do best with this type of formula because it has just the right balance of protein, carbohydrate, and fat.

The milk protein in formula is significantly altered to make it easier to digest. Your baby won't be able to digest regular cow's milk until after his first birthday.

Partially and extensively hydrolyzed formulas

In these formulas, the protein is broken down into small parts (partially hydrolyzed) or even smaller parts (extensively hydrolyzed) that are easier for your baby to digest than larger protein molecules.
The proteins in extensively hydrolyzed formulas are completely broken down into their building blocks (amino acids), which allow them to be easily absorbed. Extensively hydrolyzed formulas are considered hypoallergenic and are used for babies who have a cow's milk protein allergy.

Partially hydrolyzed formulas are not hypoallergenic, so don't use one if your baby has a milk protein allergy or if you suspect she may have one. The pediatrician might recommend trying this type of formula if, for example, your baby always seems fussy after feedings – which might indicate trouble digesting standard cow's milk formula.

Hydrolyzed formulas are also recommended when a baby has trouble absorbing nutrients (a common problem for preemies).

Soy-based formula

These formulas are made with a plant protein that, like the protein in cow's milk, is modified for easy digestion. Although soy-based formulas are a good option for vegan families, they're not recommended for preterm infants weighing less than 1,800 grams (about 4 pounds), and there are only a few medical reasons for using them. These include:
  • Transient lactose deficiency: a temporary lactose intolerance caused by a gastrointestinal infection
  • Immunoglobulin E (IgE)-associated allergy to cow's milk: an allergy to cow's milk protein that causes immediate symptoms, including wheezing, runny nose, hives, and rashes; however, many babies with IgE-associated milk allergy are also allergic to soy protein, so don't give soy formulas to your child unless your doctor recommends it
  • Galactosemia: a rare inherited disorder in which the body is unable to break down a milk sugar (galactose) to produce energy; most states test for galactosemia during newborn screening tests
  • Congenital lactase deficiency: an extremely rare inherited disorder in which a baby is born with very little or none of the enzyme that breaks down the sugar lactose found in milk, causing life-threatening lactose intolerance symptoms
Note: Research suggests that certain compounds in soy can act like the hormone estrogen in the body. In animal studies, eating a lot of soy was linked to early onset of puberty in females and changes in the development of breast tissue. If your baby drinks only soy formulas, talk with your doctor about whether it could affect your baby's development.

Lactose-free formula

Lactose intolerance or an inability to digest lactose – the sugar naturally found in milk – is rare in infants. If your baby is lactose intolerant, his doctor may recommend a soy formula or another formula in which the lactose is replaced with a different sugar, such as corn syrup.

Formula for premature and low-birth-weight babies: These formulas often contain more calories and protein, as well as a more easily absorbed type of fat called medium-chain triglycerides (MCT). How much MCT is in these formulas varies by brand. Your baby's doctor will help you select the one that will help your baby gain just the right amount of weight.

Human milk fortifier

This product is used to enrich the nutrition of breastfed babies who have special needs. It's designed to be mixed with breast milk and should not be fed as a stand-alone formula.

Metabolic formula

If your baby has a disease that requires very specific nutrition, he may need one of the specially developed metabolic formulas.

Organic formula

This type of formula allows parents to limit their baby's exposure to herbicides, pesticides, and other chemicals. Formulas labeled "organic" must be certified by the U.S. Department of Agriculture.

But according to the American Academy of Pediatrics (AAP), no research to date has proven organic milk to be healthier for children than regular milk. Parents may want to consider whether organic formula is worth the higher price.

Other specialty formulas

New formulas come out all the time that claim to relieve problems such as colic or acid reflux. These formulas have a protein ratio similar to breast milk and vary slightly in composition from regular formula, but some experts say they may not be any better.

"More often than not, specialty formulas are substantially more expensive and not significantly different in key nutritional value," says KT Park, a pediatric gastroenterologist at Stanford's Lucile Packard Children's Hospital. "Babies undergo tremendous adaptation of their gastrointestinal tract during the first six months of life, which is normal. There are very few scenarios in which infants would require the more expensive formulas."

If you think your child might benefit from a specialty formula, ask your child's doctor about it before you stock up.

What are the main ingredients in infant formula?

There are five main components to formula: carbohydrate, protein, fat, vitamins, and minerals. What makes one brand of formula different from the next are the specific carbohydrates and proteins (as well as any additional nutrients in smaller quantities). For example, casein and whey are two kinds of cow's milk proteins found in various proportions in different brands of cow's-milk-based formula.

It's very easy to get confused by all of the items listed on the ingredient label. Here's how to decipher the maze of ingredients and a comparison to the ones found in breast milk:

Carbohydrate: Lactose is the main carbohydrate in both breast milk and formulas made from cow's milk. Corn maltodextrin is sometimes used as a secondary source of carbohydrate in formula. Lactose-free, soy, and special formulas contain one or more of the following carbohydrates: sucrose, corn maltodextrin, modified cornstarch, or corn syrup solids.

Protein: Breast milk contains about 60 percent whey and 40 percent casein. Most formulas have similar protein ratio. Others contain 100 percent whey.

Soy formulas contain soy protein isolate – a processed soybean ingredient that is almost pure protein (at least 90 percent). Some brands use partially hydrolyzed soy protein (protein that is partially broken down) to allow for easier digestion.

Fat: Breast milk contains a blend of monounsaturated, polyunsaturated, and saturated fat. Formulas use a variety of oils to match the fat makeup of breast milk. They include soy oil, coconut oil, palm or palm olein oil, and high oleic sunflower oil.

Although palm and palm olein oil are widely used, research has shown that these fats can reduce absorption of fat and calcium. This would mean that your baby would not absorb as much fat and calcium as she would from a formula that doesn't contain this oil.

Medium-chain triglycerides are a form of fat that require less effort to digest and are more easily absorbed. They're used in special formulas for premature infants and for infants who have trouble digesting or absorbing nutrients.

The US Food and Drug Administration (FDA) has approved the addition of two long-chain fatty acids to formula: DHA (docosahexaenoic acid) and ARA (arachidonic acid), which are now standard ingredients in formula. Both of these substances are found in breast milk when the mother's diet is adequate, and both are important for brain and vision development.

Babies get DHA and ARA from their mother during the third trimester, but the transfer is cut short when a baby is born prematurely. All babies need a steady supply of both substances throughout their first year.

Numerous studies support the supplementation of formula with DHA and ARA. While there aren't any long-term studies confirming the safety of these substances, there's no evidence suggesting that these additives are harmful to babies, either.

The AAP hasn't taken a position on whether DHA and ARA should be added to formula, but the organization does point out that they're believed to be important in brain and eye development.

Vitamins and minerals: Most words on the ingredient label describe vitamins and minerals. These words can be hard to figure out – for example, ferrous sulfate is iron, sodium ascorbate is vitamin C, and calcium pantothenate is vitamin B5.

The AAP recommends that all healthy babies who aren't breastfed exclusively be given iron-fortified formula until their first birthday. It's important that babies receive the minimum recommended amount of iron (0.27 mg daily for infants 0 to 6 months; 11 mg daily for babies 7 to 12 months) to prevent iron-deficiency anemia.

Iron is vital to the blood's ability to circulate oxygen, which all of the body's cells need to function properly. Studies have shown that getting enough iron in the first year of life is important for brain development. A baby's iron stores are established in the third trimester, so premature babies need extra help in getting plenty of iron.

Most formulas contain at least 4 mg of iron per liter, although "low-iron" formulas are still on the shelves. These were developed years ago in response to the misconception that the iron in formula causes constipation. But the dose of iron in formula is too small to cause constipation. The AAP would like these low-iron formulas to be discontinued or labeled as nutritionally inadequate.

Nucleotides: These are the building blocks of DNA and RNA, naturally present in breast milk. They have several functions and may aid in immune system development. Different brands of formula have different amounts of nucleotides added.

Rice starch: Rice starch is added to "anti-regurgitation" formulas. Your doctor may recommend this type of formula to alleviate your baby's acid reflux.

Dietary fiber: Soy fiber is added to soy formula for the temporary treatment of diarrhea in babies who are older than 6 months and in toddlers. The only formula available containing fiber is Similac Expert Care for Diarrhea, which is clinically shown to reduce the duration of diarrhea.

Amino acids: Amino acids such as taurine, methionine, and carnitine are added to soy formulas, and sometimes to cow's-milk formulas, to match the amino acids in breast milk.

Probiotics and prebiotics: Probiotics are a type of live, "friendly" bacteria that may help prevent intestinal infections, inflammation, and diarrhea that can occur with the use of antibiotics. Prebiotics are oligosaccharides (carbohydrates found in human milk) that help boost the numbers of probiotic bacteria in the gut.

The AAP says some studies show that probiotics and prebiotics can play a role in keeping your child's digestive system healthy. But they can also be unsafe for babies with compromised immune systems and certain other medical conditions, so it's best to check with your baby's doctor before using these formulas. Any benefit from probiotics and prebiotics goes away once your baby stops using them.

Are generic brands nutritionally adequate?

Yes. Generic brands of formula must meet the FDA's requirements for nutrients in formula, so in many instances, the only difference between generic and brand name is the price. (The FDA's requirements for infant formula include minimum amounts for 29 nutrients and maximum amounts for nine nutrients.)

Whether you're buying generic or name brand, take a minute to look at the label before you purchase the formula. Specific ingredients do vary from brand to brand, and this can make a difference to your baby.

Should I try lots of different types of formula?

In general, it's best to stick with one type and resist the urge to switch, even if your baby seems like he's not digesting the formula well at first.

Common problems – like spitting up, gas, and colic – are usually unrelated to your baby's diet. Most of the time, these problems have to do with your baby's immature gastrointestinal tract, not what he's eating.

Sticking to the same formula for a while can also make it easier for your baby's doctor to figure out if there's anything else that might be causing symptoms. So ask the doctor to recommend a formula and try it for at least a couple weeks. After that, if your baby's still having trouble, talk to the doctor about switching.

Should I follow the "use by" date?

Yes. The "use by" date tells you when the nutritional quality of the formula will begin to decline. Giving your baby formula with an expired "use by" date can prevent her from getting the full nutritional benefits, so it's always best to buy formula in quantities that you're sure you'll use up by the time it expires.

Can I make my own formula?

Doctors strongly advise against it. If you make your own formula, it would be impossible to include all the ingredients in the right amounts for your baby. Homemade formula could lead to failure to gain weight, malnourishment, or even death.

What if I'm still not sure which formula is right for my baby?

If you're still overwhelmed by the options, or you're considering switching formulas, talk with your baby's doctor. He'll consider your baby's health, age, and nutritional needs, and make an appropriate recommendation.

The doctor can also monitor your baby's reactions and investigate any symptoms. Don't try to diagnose an allergy or sensitivity on your own. You could miss a serious underlying condition or prevent your baby from getting adequate nutrition.


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