How to Choose a Formula for your Baby

Introduction to Formulas

While it has been told to many women time and time again that “Breast is Best”, we know that the reality is breastfeeding does not always go as planned or is not the right fit for your family from the start. If this is the case, you have the opportunity to choose a nourishing formula for your baby.

However, on top of the never-ending list of decisions that come with raising a child, you are faced with the task of choosing the right formula…but there are so many options you don’t even know where to begin. While there is no one perfect formula, there are some things to take into consideration when picking out a formula that will be just right for your little one. We will deep dive into the different types of formulas, compare the most popular brands available today and look at how these formulas nutritionally compare to breastmilk. 

Ingredients to Look For in Infant Formulas: 

During their first year, babies experience the fastest growth and development of their lives. Because of this, baby formula is one of the most highly regulated food products. The government enforces rigorous nutrition standards for all infant formulas to ensure they receive the necessary nutrients for this critical period. Despite these rigorous standards, the ingredients in baby formulas are one of the most controversial baby topics out there, right behind natural birth vs c-section or sleep training. I hope this information helps simplify baby formula ingredients and debunk common misconceptions about which ingredients are best for your baby. 

Ingredients to look for in infant formulas include: protein, carbohydrate, and fat. Let’s take a look at protein first which can be the most influential nutrient in a baby’s tolerance to a formula. 

Protein 

Protein is a small but significant percentage of an infant’s nutrient needs. It plays a vital role in an infant’s linear growth and overall development. The main source of protein in infant formula comes from cow’s milk. Cow’s milk on its own does not contain all the necessary nutrients for growth and should not be given to babies under 12 months. Due to alterations during processing, the cow’s milk protein in infant formula is safe for a baby's digestive system. 

Cow’s milk can appear on an ingredient list as: 

• whole milk
• skimmed milk 
• non-fat milk 

 The specific cow’s milk proteins will be listed as any of the following ingredients:

• “milk protein isolate”
• “whey protein”
• “casein protein”

 Whey vs Casein 

Whey and casein are the two proteins found in milk and their ratio is important to note when choosing a formula or choosing to switch formulas. Casein has a tendency to curdle when it gets to the acidic environment of the stomach whereas whey will remain a liquid, making it easier to digest. This helps in reducing the occurrence and severity of spit ups for newborns. 

 As a reference, breast milk contains a 60:40 whey to casein ratio, so many formulas will try to replicate this same ratio to help promote rapid gastric emptying. You can examine the ingredient list to get an idea of the whey to casein ratio - ingredients are written in order from highest weight to lowest weight, so if you see whey protein listed before casein protein then it likely has the ideal ratio of 60:40 that you want to aim for. When in doubt, you can always contact the formula manufacturer to verify. 

 What Does “grass-fed” mean? 

One thing to note is some formulas will specify if their milk used is “grass-fed”, which means the cows who produced the milk used in this formula were only fed grass as opposed to corn or other grains. Cows who are only fed grass will produce milk with a higher content of omega-3 and omega-6 fats which are healthy fats known to promote brain development. Do not think that your little one will be missing out on these healthy fats if their formula does not contain “grass-fed” milk as all formulas with whole milk will still contain omega-3 and omega-6 fats, just in lesser amounts. 

Carbohydrate

Lactose is the main carbohydrate found in mature human milk so naturally formulas utilize this as the primary carbohydrate ingredient. Lactose is a naturally formed sugar and is easy to digest.

Other sources of carbohydrates that can be included in infant formulas include:

• corn syrup (or corn syrup solids)
• Maltodextrin
• glucose syrup
• sucrose (table sugar) 

It is recommended to choose a formula with lactose as the main carbohydrate ingredient to mimic the easy digestibility of human breast milk. 

 Fat

Believe it or not, fats are crucial for your baby’s nutrition and should be a top priority, as babies need plenty of them. Breastmilk contains a variety of fats that make up ~½ of the energy content. Most formulas will use a blend of different vegetable oils to mimic breast milk and achieve the variety needed to meet the nutrition standards for fats in infant formula.

Commonly used fat sources in infant formula are:

• palm oil
• canola oil
• coconut oil
• sunflower oil
• safflower oil
• soy oil    

 Why not Palm Oil? 

In regards to the ingredients listed above, palm oil is not generally recommended as an ingredient in baby formulas because studies have shown it can decrease the absorption of calcium which is an important nutrient that aids in bone development. It is preferred to choose a formula with a blend of different fat sources. 

Lastly, breast milk naturally contains long chains of polyunsaturated fats called DHA and ARA - these are the healthy fats omega-3 and omega-6 that are also found in grass-fed cow’s milk. As stated previously, these fats help promote brain development, so naturally many formula companies will add DHA & ARA to their formulas and note this on the label. While they are not identified as necessary nutrients required to be included in formulas in the US, European regulations require the addition of DHA into their formulas. If you are wanting to choose a formula with added DHA, it is recommended to look for a formula with 11.5 mg DHA per 100 mL of formula  which is the equivalent to the amount found in breast milk. 

Is Organic Best?

All foods are equal and all formulas are equal in the sense that they are highly regulated by the government and provide all the necessary nutrients needed for human growth and development. However, there are added benefits to using organic products. 

Organic formulas are considered a “healthier” option because the ingredients are free from synthetic additives, pesticides, genetically modified organisms (GMOs), and artificial additives. In order for a formula to be certified organic, at least 95% of the ingredients must be organic. Many parents are becoming more inclined to purchase organic formulas as a more natural and safe option for their baby. 

The main differences in ingredients between organic vs non-organic formula is that organic formulas aim to use organic lactose as the primary carbohydrate source, organic dairy-derived products - still achieving the ideal 60:40 whey to casein ratio -, and prioritizing organic and natural fats. 

So the question is…is organic formula better for your baby? It is more expensive and there are less options available compared to non-organic formulas, but there are no studies that show significant differences in infants who consume organic vs non-organic formula. Nevertheless, if organic formula is an option for you, I would recommend choosing an organic formula due to the reduced chemical use and absence of synthetic additives.

Powder-based vs Ready-to-Feed

 Walking through the formula aisles at the store, you may have noticed some formulas are offered in powdered form while others are liquids labeled as “concentrates” or “ready-to-feed” formulas. Both ready-to-feed and concentrated liquid formulas reduce the risk of contamination when preparing formula and also reduce the risk of improper mixing.

Due to their convenience, ready-to-feed and concentrated liquid formulas are priced higher than standard powder formulas, but they are all appropriate and safe options for your baby! 

Types of Formula Available?

Now that we have covered the basics, we can begin looking at all of the formulas available to buy…which are a lot. With modern technology has come a variety of formulas to fit every child’s specific needs, but unfortunately this makes the decision of which formula to get difficult with all the endless options out there. 

Formulas can be categorized based on two things: proteins and carbohydrates. To start, we will look at formulas categorized by the size of the protein in them…

Standard Formula - Standard infant formula uses regular-sized or intact protein from cow’s milk. These proteins are actually larger in size than the protein found in human breast milk, but generally most healthy babies are able to digest and tolerate cow’s milk protein without difficulty. Some examples of standard infant formulas include: Similac Advance, Similac 360, Similac Total Care, Enfamil Infant, Enfamil NeuroPro, Enfamil Enspire, Bobbie, ByHeart.

Hydrolyzed Formula - Hydrolyzed formulas are more gentle on the stomach and easier to digest which helps stool consistency to be more like a breastfed infant. The word “hydrolyze” means “to break down” so the casein and/or whey proteins in these formulas have been broken into smaller chains and can be categorized as being partially or extensively hydrolyzed depending on how broken down the protein chains are. Typically, a hydrolyzed formula is recommended for use in infants with signs of intolerance such as gas, constipation, bloating, and excessive spit ups. 

Commonly available hydrolyzed formulas include: Partially hydrolyzed - Similac Total Comfort, Enfamil Reguline, Enfamil Gentlease, Enspire Gentlease, Bobbie Gentle Gerber Good Start GentlePro, Gerber Good Start Soothe Pro

Extensively hydrolyzed - Nutramigen, Similac Alimentum, Extensive HA, Pepticate.

Amino Acid Formula - Lastly, amino acid formulas are broken down to the smallest protein form, an amino acid. An amino acid formula is generally only recommended for use under physician supervision and is designed to be a hypoallergenic formula, meaning it is safe for infants with cow’s milk protein allergies or other food allergies (i.e. soy, wheat, eggs, etc.). Available amino acid formulas include: Elecare, PurAmino, Alfamino, and Neocate.

Goat’s Milk Formula - There are only a select few goat’s milk formulas that are FDA (Food and Drug Administration) approved, but a lot of other countries have a variety of goat’s milk formula options available. Goat’s milk formula has a higher content of a specific form of casein protein (A2) which some studies have shown is easier to digest than the casein protein found in cow’s milk (A1). Goat’s milk formula is a good option for an infant who may not tolerate cow’s milk formula due to gas or excessive spit up, but it is not an appropriate formula for an infant with a suspected cow’s milk protein allergy due to the similarity in proteins. Goat milk formulas available for purchase in the US include: Kabrita Goat, Kendamil Goat, and Bubs Goat. 

Soy-based Formula - While soy-based formulas are a good option for parents seeking a non-dairy formula, it is also used for infants who are found to be lactose intolerant or have a metabolic disorder called galactosemia in which their body cannot digest milk sugar. There have been concerns about the effects of soy phytoestrogens on developing infants but there is not enough research to establish any significant impacts. A few similac formulas available are: Similac Soy Isomil, Enfamil Prosobee, and Gerber Good Start Gentle Soy

Modified Carbohydrate Formula - Formulas with reduced lactose and alternative carbohydrate sources such as sucrose/corn syrup or rice starch are formulated to help improve mild spit up, gassiness, and fussiness. This type of formula may be a good option for a baby with excessive spitting up with no other signs of intolerance or concern for milk protein allergy. Modified carbohydrate formulas available include: Enfamil Sensitive, Similac Sensitive, and Enfamil AR.

Why is European Formula Popular?

As stated in the beginning, baby formulas are one of the most highly regulated food products out there and each country regulates formulas to their own standards. Therefore, European formulas are not regulated by the FDA, which means they cannot determine what they contain, how they are manufactured, and even the way they are stored. On the other hand, the FDA has approved some European formulas for use in the US which is why they are appearing more in your local stores. 

With the significant emergence of purchasing more organic foods/formulas also came the popularity of European formulas. The reason for this is likely due to the perception that European formulas are “safer” or “more clean”. The European Commission has more strict guidelines than the FDA on their baby formula ingredients, including prohibitions on the use of corn syrup, corn syrup solids, and GMOs, and specific guidelines and limits for the use of sucrose. 

 Some risks of using imported formulas not approved for use by the FDA include:

• Lack of notifiability in case of a recall of a European infant formulas
• Malnutrition due to incorrect formula preparation as a result of mixing instructions in a foreign language
• Increased costs as the parent is paying both the manufacturer and the 3rd party import company

It is strongly recommended to only use European and other international formulas that have been approved for use by the FDA and can be closely monitored. A list of these formulas are as follows: Bubs, Kendamil, and Aptamil.

Formula Comparison

For the purpose of this post, we will compare a few of the most commonly purchased and recommended infant formulas on the market today in the categories of standard formula, partially hydrolyzed, goat’s milk, organic, and modified carbohydrate

Is It the Right Fit? 

The best way to know whether you have chosen the right formula or not is by giving your baby time to try it and watching how they respond. Many babies require a period of 1 to 2 weeks to adjust to a formula, and if they are consuming enough, gaining weight, and seem happy and comfortable, then you likely have chosen a formula that works well for your baby. 

Remember, you know your baby best! When in doubt or concerned, you can always reach out to your pediatrician for help.