By Dr. Steven Abrams, Neonatologist and Medical Director of Neonatology Nutrition Program
When I first started as a pediatric trainee in 1982, if an infant was going to receive a formula, which, unfortunately was most of them back then, there were only a few choices. Basically three companies marketed cow milk-based or soy-based formulas. Families asked their pediatrician which company they preferred and discussed whether a soy formula might be helpful. Life was simple even if those choices didn’t usually matter very much.
Now, it’s a virtual maze wandering through the formula aisle. There are more companies, more choices, and a complex set of information on the packages that make it very hard for anyone to know what to choose. Do I want my baby to get a “gentle” formula? Is she “sensitive?” Hmmm “organic” must be a good idea? Wait, am I supplementing breast-feeding? Do I need a formula that will “comfort” my baby? What about “spitting” up?
My children like to laugh and even write that sometimes I go to the store and wander through the infant formula aisle just so I can see what parents must face. It’s not infrequently that I spot a poor mom or dad combing the aisle desperately trying to guess what will make their baby happy (and sleepy!). I consider myself fairly knowledgeable about infant nutrition including formula choices but even I can’t guess sometimes what’s actually in a formula from its name and must read the list of ingredients, or search on the internet, to find the answer.
The basic principles:
So, let’s go through some principles to at least try to help with the formula aisle maze. Unquestionably, breast milk is the best choice for virtually every infant, but it is also true that the majority of infants in the United States will receive some formula during the first year of life. Helping their parents make good choices between formulas and understanding the options for infant formulas is not in conflict with supporting breastfeeding as long as it remains understood that “closest to breastmilk” is a long way away.
First, the good news is that all of the formulas you see that say “infant formula” on the label are safe except for the very few infants with special medical problems which should be identified by your pediatrician.
Second, there is no evidence at all that parents must or should buy the most expensive formula on the shelf or be concerned about the health benefits of lower cost formulas. I would, however, caution against frequent switching of brands based on one coupon or sale as some infants do seem to develop preferences over time and it can be very difficult for parents to determine the differences between an advertised brand of formula and the one their child has been receiving.
Third, parents can usually purchase powder as it is less expensive than pre-mixed liquid formula. A special exception to this is babies who are born prematurely who should only get ready-to-feed liquid for at least a month after their due date. Concentrated liquid formula is another option although parents must be cautious to properly dilute the concentrate with water based on the label instructions.
Fourth, from a nutritional perspective, there is no reason to choose any particular formula brand or type specifically for breast-fed infants who are receiving some supplemental formula. Marketing in this way should not be confused for evidence of a need for a unique formula choice in babies who are partially or primarily breastfed.
Special conditions:
Now, beyond that, it gets tougher. For the most part, babies will often have colic, spitting (reflux), upset stomachs, or mild allergic symptoms that do not necessarily require violating rule #2 above. Formulas marketed as improving one or more of these symptoms may or may not be successful in an individual baby. In general, I recommend that for most concerns such as spitting, parents try other behavioral and feeding techniques before switching to formulas marketed using vague terms such as “gentle,” “comfort,” or “sensitive.” It is not uncommon for a baby to have been tried on three or more formulas without any real difference in these symptoms. Often a baby grows out of the problem at the same time as yet another formula switch is made leading to uncertainty related to long-term formula selection.
Having said that, there are some babies who improve on specialized formulas, especially the often more expensive formulas designed to deal with severe allergic symptoms or severe reflux that might uncommonly be affecting growth. Formulas with probiotics (beneficial bacteria) may be helpful in some infants with colic although recent studies are not conclusive regarding this issue. I believe that in every such case, a family should carefully consult with their pediatrician before purchasing or using one of these formulas.
The right pediatrician:
Finally, a key message to parents is that just as it is important to find a breast-feeding friendly and knowledgeable pediatrician, it is also important to make sure that your pediatrician can properly guide you through the formula aisle should you choose to provide an infant formula. Ask questions about why a formula choice is being recommended and whether a lower cost one, or a more readily available one, can be tried. If a specialized formula is started for your infant, remind your pediatrician regularly about this and ask if it would be possible to switch to a more routine one after a month or two. Go through the symptoms your baby is having with your pediatrician and see if the formula descriptions I mentioned earlier (e.g. for spit up, for comfort, being gentle, or organic certified) are ones that truly match what is best for your baby.
In summary, I wish you the best of luck traversing the formula aisle. Don’t forget to send occasional notes to the companies that make these formulas if you’re confused by what is being sold. I sure do!
Dr. Steven Abrams is a Texas Children’s Hospital neonatologist and Medical Director of the Neonatology Nutrition Program at Baylor College of Medicine. Like what you read? Check out our expert posts section to hear more from the vast knowledge of our doctors and other experts right here at Texas Children’s.
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