By: George J. Fuchs III, MD, FAAP & Steven A. Abrams, MD, FAAP
To keep baby formulas safe, the U.S. government and the Food and Drug Administration (FDA) have rules about what goes into them and how they are made and sold. When shopping for infant formula, you'll find several basic types.
Baby formulas may contain
cow's milk, goat's milk or soy protein. The FDA requires infant formula to have 30 nutrients that your growing baby needs.
Types of infant formula
Cow's milk–based baby formula
Cow's milk–based formulas account for a majority of the formula sold. Although cow's milk is the basis for such formulas, the milk has been changed dramatically to make it safe and nutritious for infants. It is treated by heating and other methods to make the protein more digestible. More milk sugar (lactose) is added to make the concentration equal to that found in breast milk. Also, the butterfat is partly or completely removed and usually replaced with vegetable oils and other fats that infants can more easily digest and are better for infant growth.
Goat's milk baby formula
Previously not permitted by the FDA in the United States, there are now several manufacturers who produce goat's milk based infant formula that can be purchased and used. These goat's milk infant formula products are adapted for baby formula to support normal growth and development in infants.
Some people believe that goat's milk baby formula may be tolerated better than formula based on cow milk or soy protein, with less upset stomachs or allergic responses, but that's not certain.
Infants who are allergic to cow's milk (formula) should not use products made with goat's milk or milk from other mammals because of high rates of cross-reactivity with cow's milk proteins and risk for allergic reactions.
Why iron-fortified baby formula is important
Nearly all infant formulas have additional iron added. These iron-fortified formulas have dramatically reduced the rate of
iron deficiency and iron-deficient anemia in infancy in recent decades. Some infants do not have enough natural reserves of iron, a mineral necessary for normal human growth and development.
That's why the American Academy of Pediatrics (AAP) currently recommends that iron-fortified formula be used for all infants who are not
breastfed, or who are only partially breastfed, from birth to one year of age. Additional iron is available in many foods (including baby food), especially in meats, egg yolks and iron-fortified cereals.
Low-iron formulas should not be used. Some parents worry about iron causing
constipation, but the amount of iron in infant formula does not contribute to constipation or upset stomach. Most formulas also have docosahexaenoic acid (DHA) and arachidonic acid (ARA) added to them, fatty acids, believed to be important for the development of a baby's brain and eyes.
Extensively hydrolyzed baby formula
Another type of formula is extensively hydrolyzed formula. This type of formula is often called "predigested," since the protein content has already been broken down into smaller proteins that can be digested more easily.
Ask your pediatrician to recommend a brand of hypoallergenic formula if your baby needs it for allergies or other conditions. However, these extensively hydrolyzed formulas tend to be costlier than regular formulas.
Soy formulas for babies
Soy formulas contain a protein (soy) and carbohydrate (either glucose or sucrose) different from milk-based formulas. They are sometimes recommended for babies unable to digest lactose. Lactose is the main carbohydrate in cow's milk formula although this is very uncommon. (See more about lactose intolerance below.)
Specialized baby formulas
There are specialized formulas for infants with specific disorders or diseases, including for premature babies. If your pediatrician recommends a specialized formula for your infant, follow their guidance about feeding requirements (amounts, scheduling, special preparations), since these may be quite different from regular formulas.
What about toddler "formulas," milks or drinks?
The formula aisle at your local supermarket has expanded in the past few years. Next to infant formula products you will often see products labeled specifically
for older babies and toddlers. The products have names like, "follow-up formula," "weaning formula," "toddler milk" or "toddler formula." These names are misleading, because the products are not a necessary part of a healthy child's diet or equivalent to infant formula in any way. Some are labeled with unproven health claims.
Special drinks for toddlers are not needed to meet your child's nutritional needs. They often have added sugar, salt and protein, or not enough protein. Be sure to check the product label when shopping for infant formula. Do not feed babies younger than age 12 months milks, drinks or "formula" for toddlers. Infant formula includes all the ingredients in the right amount for your baby.
Baby formulas supplemented with probiotics
Some formulas also are fortified with probiotics, which are types of "friendly" bacteria. Others are now fortified with prebiotics in the form of manufactured oligosaccharides. Formulas fortified with these prebiotics attempt to mimic the natural human milk oligosaccharides, which are substances that promote healthy intestinal lining and gut function. There is no strong evidence of benefit from the use of these formulas.
Common concerns & considerations when choosing a baby formula
Lactose intolerance
A few infants have brief periods when they cannot digest lactose, particularly following bouts of diarrhea, which can damage the digestive enzymes in the lining of the intestines. But this is usually only a temporary problem and does not require a change in your baby's diet.
It is extremely rare for babies to have a significant problem digesting and absorbing lactose (although it tends to occur in older children and adults). While lactose-free formulas are fine sources of nutrition, check with your pediatrician before starting your baby on a lactose-free formula, since whatever problem they may be having is likely due to something else and lactose is the natural sugar in breast milk and may be ideal for nearly all babies.
Milk allergy
With a true
milk allergy causing colic, failure to thrive, vomiting, or even bloody diarrhea, the allergy is to the protein in the cow's milk formula. In this case soy formulas may seem like a good alternative.
However, soy formulas are not recommended in infants with cow milk allergy because up to half the infants who have milk allergy are also sensitive to soy protein and therefore must be given specialized formula (such as amino-based or elemental) or breast milk. Always discuss with your pediatrician before selecting these expensive formulas that are often widely overused.
Galactosemia
The AAP believes that there are few circumstances in which soy formula should be chosen instead of cow's milk–based formula. However, one of these situations is in infants with a rare disorder called galactosemia; children with this condition have an intolerance to galactose, one of the two sugars in lactose. These babies cannot tolerate breast milk and must be fed a lactose-free formula.
All states include a test for galactosemia in
routine newborn screening after birth.
Vegetarian & vegan concerns
Some strict vegetarian and vegan parents choose to use soy formula because it contains no animal products. Remember that breastfeeding is the best option for vegetarian families. And while some parents believe a soy formula might prevent or ease the symptoms of colic or fussiness, there is no evidence to support this.
More information
About Dr. Fuchs
George J. Fuchs III, MD, FAAP, a member of the American Academy of Pediatrics Committee on Nutrition, is a board-certified pediatrician and board-certified pediatric gastroenterologist. He is Professor and former Vice Chair for Clinical Affairs, Department of Pediatrics and Chief of Pediatric Gastroenterology, at the University of Kentucky and Kentucky Children’s Hospital. He is a member of the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition, as well as the Infectious Diseases Society of America.
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About Dr. Abrams
 Steven A. Abrams, MD, FAAP, is a board-certified pediatrician and neonatologist, and a Professor of Pediatrics at the University of Texas at Austin. Within the American Academy of Pediatrics, he is the former chair of the Committee on Nutrition. Dr. Abrams also serves on the Dietary Guidelines Advisory Committee and is editor-in-chief of Advances in Nutrition, published by the American Society for Nutrition.
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