Meet Dina DiMaggio, MD, and Anthony F. Porto MD, MPH, official spokespeople for the American Academy of Pediatrics and the co-authors of The Pediatrician’s Guide to Feeding Babies and Toddlers. Each month, they’ll write about the latest AAP guidelines, studies and seasonal issues affecting babies and toddlers. Follow them on Instagram @pediatriciansguide.
As you’re probably well aware, the American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first six months of baby’s life. But for parents who need or want to give formula to their infants, there’s hardly such a straightward recommendation. While most commercial infant formulas have been developed based on extensive research and aim to replicate the nutrition of human breast milk as closely as possible, there are so many on the market that choosing the right one may seem overwhelming.
We’re here to help. Here are 10 things you should know about choosing an infant formula:
There is no one best formula
Different babies may do better with different formulas. For healthy full-term infants, we typically start with a cow’s milk–based formula, such as Enfamil Complete, Similac Advance or the store-brand equivalent. There are also organic versions of these formulas available as well, such as Earth’s Best Organic. For vegetarians or vegans, soy-based formulas can be used instead.
Formulas for children with acid reflux or colic are available, though often not necessary
Though most children will do well on a traditional cow’s milk protein formula, there are many formulas on the market that have different or added components.
Anti-reflux formulas are marketed to help treat children with spit-up. Though gastroesophageal reflux is nearly universal in babies, most children who are spitting up but growing well will not require any treatment or change in formula. Of the major infant formula brands, there are currently two different products on the market, Enfamil AR and Similac for Spit-up, where rice has been added to the formula to help decrease spit-up.
Sensitive formulas are typically lactose free, or contain limited lactose, and have a higher whey to casein ratio to closely mimic breast milk. They may also contain partially broken down whey protein (Gerber Good Start), which is thought to be easier to digest and may decrease gas production. Some of these formulas may also contain prebiotics (the majority of Similac formulas), while others contain probiotics (Gerber Good Start Gentle for Supplementing and Gerber Good Start Soothe), which may decrease gas and symptoms of colic.
All additives to infant formulas are regulated by the FDA, which requires proof of safety and efficacy for each additive. The benefits of changing formulas, however, vary from child to child. We often see parents change formula during the peak of colic, around 6 to 8 weeks, when babies may appear gassier or more fussy, but this colic phase generally tends to resolve on its own around 3 to 4 months, regardless of formula changes.
Calories in formula typically mimic that of breast milk
When mixed, most formulas contain approximately twenty calories per ounce. However, since it is estimated that breast milk contains between eighteen to twenty calories per ounce, some formulas (like Similac Advance) have changed the concentration so that they contain nineteen calories per ounce when mixed. One calorie is not a major difference, but can be important if your child is not gaining weight appropriately.
Formula preparation depends on whether you use powder, concentrate or ready-to-feed
Formulas come in three different forms: powder, concentrate and ready-to-feed. In most cases, when using powder formula, you place two ounces of water in the bottle, then add one level scoop of powder formula to the bottle and shake well. It is important to read the labels since some formulas, including some amino-acid based formulas, such as Neocate and PurAmino, need to be mixed at a different ratio, with one ounce of water for every one scoop of formula.
Concentrate formula should be mixed at a one-to-one ratio with water. Most containers come in 13 oz. bottles, so if you mix 13 oz. of water with the entire contents, you will have 26 oz. of formula. This formula can be refrigerated for up to 48 hours. Alternatively, if you prefer to make one bottle at a time and want to make a 4 oz. bottle, you can add 2 oz. of the…
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