Best Baby Formulas Recommended by Pediatricians 2022

By Dr Frank Yap, MD

 Although the American Academy of Pediatrics and the American Academy of Family Physicians recommend breast milk for optimal infant nutrition, many parents still choose formula as an acceptable alternative. 

The wide variety of available formulas is confusing to parents and physicians, but formulas can be classified according to three basic criteria: caloric density, carbohydrate source, and protein composition. Most infants require a term formula with iron. There is insufficient evidence to recommend supplementation with docosahexaenoic acid or arachidonic acid. 

Soy formulas are indicated for congenital lactase deficiency and galactosemia, but are not recommended for colic because of insufficient evidence of benefit. 

Hypoallergenic formulas with extensively hydrolyzed protein are effective for the treatment of milk protein allergy and the prevention of atopic disease in high-risk infants. 

Anti Reflux Formulas decrease emesis and regurgitation, but have not been shown to affect growth or development. Most infants with reflux require no treatment. 

Family physicians can use these guidelines to counsel parents about infant formula, countering consumer advertising that is not evidence-based.  

This article is based on AAFP.org's article on Infant Formula. 





A. Term Formula - Appropriate for Most Infants

Most infants need a basic formula for term infants. These formulas are modeled after breast milk and contain 20 kcal per ounce. Their carbohydrate source is lactose, and they contain cow's-milk protein. There is no evidence to recommend one brand over another; all formulas are nutritionally interchangeable.

All infants should receive iron-fortified formula to prevent iron deficiency anemia. Low-iron formulas are commercially available, and some parents choose these formulas with the belief that iron causes stomach upset. Family physicians should strongly counsel parents to not use these products.

1. Carnation / Gerber Good Start - Amazon

2. Enfamil with Iron - Amazon

3. Similac with Iron - Amazon


B. Term Formula with DHA and AA

Recently, formulas with long-chain polyunsaturated fatty acids have been heavily marketed to promote eye and brain development. 

Arachidonic acid (AA) and docosahexaenoic acid (DHA) are the most common additives. These fatty acids are found in breast milk, but not conventional formula, and are thought to be important in the development of membrane constituents in the central nervous system. 

Clinical trials of the effects of AA and DHA on cognitive, social, and motor development have been inconsistent. Although no harm has been demonstrated, most well-conducted randomized trials show no benefit. Thus, recent Cochrane reviews conclude that supplementation of formula with DHA and AA cannot be recommended based on current evidence. Additionally, these formulas cost more than formulas without the above additives.

Milk Formulas with DHA and ARA

4. Enfamil Lipil

5. Gerber Good Start with DHA and ARA - Amazon

6. Similac Advance - Amazon


C. Preterm and Enriched Formula

Preterm infants have higher protein and calorie requirements. In addition, they need more calcium, magnesium, and phosphorus (minerals transferred in utero during the third trimester). These special requirements led to the development of enriched and preterm formulas designed to facilitate “catch-up” growth. 

Preterm formulas contain 24 kcal per ounce, whereas enriched formulas contain 22 kcal per ounce. Enriched formulas are available in stores as liquid or powder. Preterm formulas must be ordered in ready-to-feed bottles and are more expensive.

It is currently the standard of care to prescribe these formulas for preterm infants. Cut-offs for weight and gestational age are based on expert opinion, with variation between institutions. Infants are usually transitioned from 24 to 22 kcal per ounce when they achieve a weight of 1,800 g (3 lb, 15 oz) or 34 weeks' gestational age.

Hospital discharge is rare before 34 weeks, so infants presenting for outpatient care are typically on 22-kcal formula. There are no studies to guide timing for the discontinuation of enriched formula. Although preterm and enriched formulas may improve short-term growth parameters, they do not appear to affect longer-term growth or development at 18 months of age.

Formula for Preterm Infants
- Less than 34 weeks' gestation 
- Weight less than 1,800 g (3 lb, 15 oz)

7. Enfamil 24 Premature - Enfamil.com

8. Preemie SMA 24 

9. Similac 24 Special Care - Abbot Store


Enriched Formula
- 34 to 36 weeks' gestation 
- Weight 1,800 g (3 lb, 15 oz) or greater

10. Enfacare - Amazon

11. Similac Neosure - Amazon



D. Soy Formula

These formulas are made with corn-based carbohydrate and soy protein, making them free of lactose and cow's-milk protein. Many parents believe that this improves digestibility.

According to a recent guideline from the AAP, the use of soy formula should be limited to infants with galactosemia or congenital lactase deficiency Soy formula may also be used by strict vegan families who wish to avoid animal protein. The AAP guideline cites a lack of proven benefit for other conditions including milk protein allergy, generalized colic, and acute gastroenteritis.

One cohort study identified soy formula as a risk factor for the development of peanut allergy (odds ratio = 2.6; 95% confidence interval, 1.3 to 5.2). A subsequent randomized controlled trial failed to demonstrate any such association. Thus, the evidence regarding soy formula and peanut allergy is mixed; additional studies are needed. Soy formulas are not effective for the prevention of atopic disease.

Soy formula has been shown to reduce the duration of diarrhea in acute gastroenteritis, but does not impact overall recovery. The AAP recommends that previously well infants with gastroenteritis can return to breast milk or cow's-milk–based formulas after rehydration.

Soy protein contains phytoestrogens and isoflavones, which have been shown to have estrogenic effects in animals. Early concerns were raised that these compounds might have deleterious hormonal effects on growing infants. A retrospective cohort study demonstrated increased menstrual bleeding in women exposed to soy during infancy, but found no statistical difference in more than 30 other variables studied. Feminization has not been seen in male infants fed soy protein.

Multiple studies have confirmed normal growth in term infants fed soy formula. In contrast, preterm infants have significantly less weight gain when they are fed soy formula instead of standard formula with similar caloric density. Osteopenia of prematurity is also increased. Thus, soy formula should never be used for preterm infants.

Despite widespread use of soy formula, evidence-based indications are limited. Family physicians should direct parents toward breastfeeding and cow's-milk–based formulas in most cases.

Soy Formulas for Babies

12. Enfamil Prosobee - Amazon

13. Good Start Soy - Amazon

14. Similac Isomil - Amazon



E. Lactose Free Formula

Lactose-free formulas are an alternative to soy formula for parents wishing to avoid lactose. Lactose-free formulas are indicated for galactosemia and congenital lactase deficiency, as well as primary lactase deficiency. 

Infants with perceived gastrointestinal symptoms require a hydrogen breath test or intestinal biopsy to formally diagnose lactase deficiency. In reality, most physicians instead suggest a trial of lactose-free formula to see if symptoms improve. Lactose intolerance is over-diagnosed in infancy; most proven cases develop after 12 months of age.

Temporary lactase deficiency can also occur following acute gastroenteritis. Soy and lactose-free formulas shorten the course of diarrhea, but do not change overall recovery or weight two weeks after the illness. Most infants can safely continue breast milk or standard formula during diarrheal illnesses. At-risk infants (those younger than three months or those who are malnourished) might benefit from a switch to lactose-free formula following acute gastroenteritis.

Lactose Free Formula Milk for Babies 

15. Enfamil Lactofree 

16. (Alternatively) Enfamil Neuropro Sensitive - Amazon

17. Similac Sensitive - Amazon



F. Hypoallergenic and Non-Allergenic Formula

Only a small minority of infants have true immunoglobulin E (IgE)-mediated milk protein allergy. In these cases, infants form antibodies against large protein molecules in cow's milk. 

Milk protein allergy can present with any combination of cutaneous, respiratory, and gastrointestinal complaints; blood in the stool is a classic symptom. Milk protein allergy is usually diagnosed in the setting of a strong family history of allergies or atopic disease. 

Referral to an allergist may be helpful because skin prick tests and IgE levels for cow's-milk protein are available. Non-IgE-mediated cow's-milk protein intolerance can manifest as enteropathy and enterocolitis. Because most infants with milk-induced enteropathy will be equally sensitive to soy protein, hypoallergenic and nonallergenic formulas are the preferred alternatives.

Hypoallergenic formulas contain extensively hydrolyzed proteins that are less likely to stimulate antibody production. Infants with milk protein allergy fed hypoallergenic formula have slightly greater weight gain during the first year than infants fed standard formula. In addition, many infants show improvement in atopic symptoms. A few infants continue to have symptoms despite switching to hypoallergenic formula; nonallergenic amino acid–based formulas are effective for these rare cases.

The increasing incidence of asthma, eczema, and food allergy has led to substantial interest in the prevention of atopic disease. There is strong evidence that exclusive breastfeeding until at least four months of age decreases the incidence of eczema and protects against wheezing. It appears that formulas with extensively hydrolyzed proteins may also have protective benefits,16 but the higher expense of hypoallergenic formulas must be considered when deciding whether to recommend them for prevention in asymptomatic infants. Amino acid–based formulas have not been studied for prevention of atopic disease.

Hypoallergenic Infant Formula

18. Similac Alimentum - Amazon

19. Enfamil Nutramigen - Amazon

20. Enfamil Pregestimil 


Non-Allergenic Infant Formula

21. Elecare - Amazon

22. Neocate - Amazon

23. Nutramigen AA - Enfamil.com


G. Anti-Reflux Formula

Gastroesophageal reflux is common in infants partly because of a decreased resting tone of the lower esophageal sphincter. Reflux may be considered physiologic and does not require treatment unless it is accompanied by poor weight gain or significant infant discomfort. Nevertheless, reflux is a common source of parental concern, creating demand for antireflux formulas thickened with added rice starch. 

Before commercial development of these formulas, parents had to add rice cereal or another carbohydrate to standard infant formula. Prethickened formulas are more convenient and do not require enlargement of nipple holes (as required when rice cereal is added to standard formula).

Antireflux formulas have been shown to decrease daily episodes of regurgitation and emesis. It is not clear whether they improve long-term outcomes, such as growth or development. Although most parents should be reassured that gastroesophageal reflux is normal and will resolve with time, antireflux formulas appear safe and nutritionally adequate for severe or persistent cases.

Milk Formula for Reflux Babies

24. Enfamil AR - Amazon

25. Similac Sensitive RS - Amazon



H. Toddler Formula

Recently, toddler or “next step” formulas have been developed for children 9 to 24 months of age. These milk-based formulas contain added iron, vitamin C, vitamin E, and zinc. They also contain DHA and AA and more calcium than standard infant formulas (but not significantly more than whole milk).

Manufacturers' information describes toddler formula as “insurance” or “extra nutrition” for picky toddlers who may not eat a well-balanced diet of solids. There is no evidence of advantage over whole milk in terms of growth or development; head-to-head trials are needed. Because toddler formulas are significantly more expensive than whole milk, family physicians can counsel parents against routine use. Parents who remain concerned about picky eaters could be directed toward a multivitamin instead.


Milk Formula for Toddlers
 
26. Enfamil Next Step - Enfamil.com

27. Good Start 2 - Amazon

28. Similac Go and Grow - Amazon



FAQ

Infant Formula and Colic

Parents often change formulas in response to infant colic. Soy and lactose-free formulas are heavily marketed for colic without a formal diagnosis of lactose intolerance. Most colic improves spontaneously between four and six months of age; new formulas tried during this time may be credited with the improvement, perpetuating the popular belief that colic is exacerbated by certain formulas.

Because evidence for soy formula in the treatment of colic is limited and based on poor-quality trials, the AAP concluded that there is no proven role for soy in the management or prevention of colic. There is no evidence to support lactose-free formula either, but a short trial may be reasonable in infants with colic who also have gastrointestinal symptoms. Two systematic reviews have found some benefit with hypoallergenic formula; this potential benefit must be weighed against substantially greater cost. Physicians may recommend a one- to two-week trial of hypoallergenic formula for refractory cases. Counseling parents about infant crying appears to reduce symptoms of colic more than any change in formula.


Read more articles on Parenting: Parenting series

Comments

Post a Comment

Popular posts from this blog

I-LONGEVITY Protocol: Anti Aging Guide to Help People Prevent and Reverse Aging (2024)

By
Image
Introduction Can diet, lifestyle and supplements reverse your age? Dive into 1,000+ research studies to find out. Current AI tools like ChatGPT, Gemini from Google and Copilot from Microsoft might return generic answers to your questions. While these can be a starting point, they often lack the depth and updated references you might crave for your research. If you are in the anti aging, longevity or biohacking space, chances are you have heard about Dr  David Sinclair  and  Bryan Johnson . Although both of them do share many longevity related strategies, their recommendations might be too overwhelming for an average layperson. You should also consult your doctor before starting any new diet and supplement program to ensure safety and suitability for your individual needs. That's where this guide is all about. We've delved into the research to provide you with more than just basic advice. We've done the research, so that you don't have to. We'll not only share suppor
Read more

18 Best Supplements to Reduce Cytokine Storm: Advanced Guide

By
Image
As of May 2024, there are more than 4,000 early treatment studies  that have been published and shared with the whole world. New ones are being added every day.  This is a review of the literature, covering multiple observational studies, randomized controlled trials and references related to natural supplements and cytokine storm with more than 300 studies and references. We know that while a large percentage of the population only experiences mild to moderate symptoms of COVID-19 and won’t require hospitalization, others experience severe symptoms and complications, require hospitalization, or may even die.  It appears one of the differences between those who have a mild illness and severe illness is related to the body's ability to reduce the hyperimmune response that leads to a cytokine storm and the hyper-coagulability (tendency for blood clots) that often accompanies it. The cytokine storm may be one possible way to explain the
Read more

NAC vs NAD vs NR vs NMN vs Niacin: What Are the Differences?

By
Image
NAC vs NAD vs Niacin vs NR vs NMN . Due to the small alphabetical differences, these supplements are often mixed up and confused by most consumers. We will cover the essentials and explain about each of these supplements below. Contents NAD NAD vs NAD+ NAD+ for Anti Aging NAD+ Helps Restore Age-Related Muscle Deterioration NAD and Resveratrol NAD Supplements NAC Niacin (NA) NR NMN NAC vs NMN Gluthatione vs NAC NAC vs Niacin NR vs NMN Can you take NR and NMN together? Niacin vs NR vs NMN Stability and Storage of NMN and NR Naturally Boosting NAD Levels Related Articles NAD NAD is a type of coenzyme found in all living cells. NAD plays important roles in a variety of metabolic reactions, including energy production and DNA repair. NAD is derived from Nicotinamide Riboside (NR) and various other precu
Read more

Zinc Gluconate vs Zinc Picolinate: What's the Difference?

By
Image
Zinc picolinate and zinc gluconate are forms of dietary supplements that we use to prevent zinc deficiency.  Zinc  is an essential mineral that our body can easily absorb. Therefore, if we do not get enough amount of zinc, we may have to take these dietary supplements as directed by the doctor. When choosing a zinc supplement, it’s important to consider the type of zinc, dosage, and supplement form. Types of Zinc Supplements   There are several types of zinc supplements. Supplements contain several forms of zinc, including zinc gluconate, zinc citrate and zinc picolinate. The percentage of elemental zinc varies by form.  Chelated zinc is a general form of supplementary zinc in which the zinc is chelated — or bound — to a compound to make it easier for the body to absorb. Zinc picolinate or zinc gluconate are formed when zinc is chelated to picolinic acid or gluconic acid, so the main dif
Read more

Vitamin D 25 Hydroxy and Vitamin D 1 25 Dihydroxy: What's the Difference?

By
Image
Vitamin D is more than just one vitamin. It’s a family of nutrients that shares similarities in chemical structure. Vitamin D helps your body absorb calcium and maintain strong bones throughout your entire life. Your body produces vitamin D when the sun’s UV rays contact your skin. Other good sources of the vitamin include fish, eggs, and fortified dairy products. It’s also available as a dietary supplement. In your diet, the most commonly found members are vitamin D2 and D3. While both types help you meet your vitamin D requirements, they differ in a few important ways. Research even suggests that vitamin D2 is less effective than vitamin D3 at raising blood levels of vitamin D. Dietary vitamin D comes in two main forms: Vitamin D2 (ergocalciferol) Vitamin D3 (cholecalciferol) The two forms of vitamin D differ depending on their food sources. Vitamin D3 is only found in animal-sourced foods, whereas D2 mainly comes from plant sources and fortified foods. Your skin makes vitamin D3 whe
Read more

10 Best NMN Supplements (2024 Review)

By
Image
NMN stands for nicotinamide mononucleotide and is a precursor to NAD+, or nicotinamide adenine dinucleotide. NMN is the direct precursor of the essential molecule nicotinamide adenine dinucleotide (NAD+) and is considered a key component to increase NAD+ levels in cells. NAD+ is a critical molecule found in every cell of your body, but levels of NAD+ naturally fall with age, making it — and NMN, as a result — crucial. NMN is one of the most popular supplements in the anti aging community. The global Nicotinamide Mononucleotide (NMN) market was valued at US$ 98.5 million in 2019 and it is expected to reach US$ 296.5 million ( R ) by the end of 2026, growing at a CAGR (Compound Annual Growth Rate) of 7.3% during 2021-2026. The NAD story took off toward the end of 2013 with a  high-profile paper  by Harvard's David Sinclair and colleagues. Sinclair, recall, achieved fame in the mid-2000s for research on yeast and mice that suggested the red wine ingredient resvera
Read more

12 Best Vitamin D3 Supplements of 2024

By
Image
Vitamin D is a fat-soluble vitamin, meaning that it dissolves in fats and oils and can be stored in your body for a long time. Two main dietary forms exist: Vitamin D3 (cholecalciferol). Found in some animal foods, like fatty fish and egg yolks. Vitamin D2 (ergocalciferol). Found in some plants, mushrooms, and yeasts. The Global Vitamin D Market size was worth US$ 1.1 billion in 2022 ( R ), and it is estimated to reach a valuation of US$ 1.7 billion by the end of 2028, expanding at an annual compound rate of 7.0% between 2023 and 2028. What is Vitamin D Good For? Vitamin D helps keep you bones strong by aiding in the absorption of calcium and phosphorus. It's involved in maintaining a healthy immune system, mood regulation, heart health, and even weight loss .  What is the Best Form of Vitamin D?  Vitamin D is a fat-soluble vitamin, meaning that it does not dissolve in water and is absorbed best in your bloodstream wh
Read more

Private Hospital and Government Hospital Charges in Malaysia

By
Image
Ever wondered How Much Does It Cost to be admitted in a private hospital or a government hospital in Malaysia? Find out and compare hospital charges below. Although the numbers and statistics are everywhere on the internet, we have compiled and organised the information accordingly in one place. The pricing information below is based on the published prices from major centres and pricing information available on blogs and the internet. Here is the list, categorised by Government Hospital Charges and Private Hospital Charges. GOVERNMENT HOSPITAL CHARGES IN MALAYSIA The average cost of popular medical procedures in public hospitals in Malaysia: Angioplasty: RM 200 Cataract: RM 500 / eye Chemotherapy: RM 200/visit Dengue: F.O.C. Heart Bypass: RM 4,000 Hip Replacement: RM 15,000 Kidney Stone: RM 10,000 Spine Surgery: RM 36,000 Stroke: RM 5,000 Additional Medical Costs That You May Need to Pay For Of course, the costs of the medical procedures above aren’t the onl
Read more

PicoWay vs PicoSure vs PicoPlus vs PicoCare: What are the Differences?

By
Image
If you are confused about all the pico laser treatments in town and are looking for a guide to better understand pico laser and pigmentation treatment, you've come to the right place. “Pico Laser” is a recent buzzword in aesthetic medicine, so it's no surprise that Pico Lasers are one of the most popular treatment nowadays. However, the science is also mixed with hype and you are likely to get overwhelmed and cluttered over this Pico Laser treatment. We have compiled related pico laser questions and answers in one place in order to answer the above question and to de-clutter your mind. All answers are provided by medical doctors and dermatologists. The information below is based on published answers from major sites on the internet. Here is the list: Q: I am looking for a treatment for melasma, pore size reduction and rejuvenation. I came across pico technology but what is the difference between Pico Way and Pico Sure ( apart from a manufacturer). Is one better than the
Read more

Hydroxychloroquine + Zinc Study: Dr Harvey Risch from Yale (American Journal of Medicine) 2021

By
Image
Early on in the COVID-19 pandemic, doctors around the world reported high success rates using an inexpensive treatment protocol of hydroxychloroquine (HCQ) and zinc, typically in combination with an antibiotic to treat secondary bacterial infections. On July 23, 2020, Dr. Harvey Risch, professor of epidemiology at Yale School of Public Health, published an op-ed in Newsweek in which he expressed his dismay and frustration:3 “I have authored over 300 peer-reviewed publications and currently hold senior positions on the editorial boards of several leading journals. I am usually accustomed to advocating for positions within the mainstream of medicine, so have been flummoxed to find that, in the midst of a crisis, I am fighting for a treatment that the data fully support but which, for reasons having nothing to do with a correct understanding of the science, has been pushed to the sidelines. As a result, tens of thousands of patients with COVID-19 are dying unnecessarily … I am referring,
Read more