A variety of formulas are available for infants younger than 12 months old who are not drinking breast milk. Infant formulas vary in nutrients, calorie count, taste, ability to be digested, and cost.
Guidelines for infant formulas and normal infant feeding based on human breast milk are available from the American Academy of Pediatrics (AAP).
SPECIFIC TYPES OF FORMULAS
Standard milk-based formulas:
Almost all babies and infants do well on these formulas. Fussiness and colic are common problems. Most of the time, cow's milk formulas are not the cause of these symptoms and parents do not need to switch to a different formula.
These formulas are made with cow's milk protein that has been changed to be more like breast milk. Lactose and minerals from the cow's milk, as well as vegetable oils, minerals, and vitamins are also in the formula.
These formulas are made using soy proteins. They do not contain lactose. The American Academy of Pediatrics recommends soy formulas for parents who do not want their child to eat animal protein, and for infants with galactosemia or congenital lactase deficiency.
Soy-based formulas have not been proven to help with milk allergies or colic. Babies who are allergic to cows' milk may also be allergic to soy milk.
This type of formula may be helpful for infants who have true allergies to milk protein, and for those with skin rashes or wheezing caused by allergies.
Hypoallergenic formulas are generally much more expensive than regular formulas.
These formulas are used for galactosemia, congenital lactase deficiency, and primary lactase deficiency. Lactase deficiency most often begins after a child is 12 months old. The condition is diagnosed using special tests.
A child who has an illness with diarrhea usually will not need lactose-free formula.
Special formulas that should be used only under a health care provider's supervision:
Reflux formulas are pre-thickened with rice starch. They are usually needed only for infants with reflux who are not gaining weight or who are very uncomfortable.
Formulas for premature and low-birthweight infants have extra calories and minerals to meet the needs of these infants.
Special formulas may be used for infants with heart disease, malabsorption syndromes, and problems digesting fat or processing certain amino acids.
Newer formulas with no clear role:
Toddler formulas are offered as added nutrition for toddlers who are picky eaters. To date, they have not been shown to be better than whole milk and multivitamins. They are also expensive.
Most formulas can be purchased in the following forms:
Ready-to-use -- do not need to be prepared with water
Powdered formulas -- must be mixed with water, but are the least expensive form
Concentrated liquid formulas -- also need to be mixed with water
The AAP recommends that all infants be fed breast milk or iron-fortified formula for at least 12 months.
Standard formulas contain 20 Kcal/ounce and 0.45 grams of protein/ounce. Formulas based on cow's milk are appropriate for most full-term and preterm infants.
Infants who drink enough formula and are gaining weight usually do not need extra vitamins or minerals. Your doctor or nurse may prescribe extra fluoride if the formula is being made with water that has not been fluorinated.
Infant formula can be used until a child is 1 year old. The American Academy of Pediatrics does not recommend cow's milk for children under 1 year old. After 1 year, the child should only get whole milk, not skim or reduced-fat milk.
PREPARING, FEEDING WITH, CLEANING, AND STORING FORMULA
Clean bottles and nipples with soap and then boil them in a covered pan for 10 minutes. They should cool while still covered.
Parents can make enough formula to last for up to 24 hours.
Make formula as directed. DO NOT water it down or make it stronger than recommended. This can cause your child to have pain, not grow well, or rarely, to have more severe problems. DO NOT add sugar to formula.
Store cans of powdered formula in a cool, dry place with a plastic lid on top. Always wash your hands and the top of the container before handling.
Once it is made, store formula in the refrigerator in individual bottles or a pitcher that has a closed lid. During the first month, your baby may need at least eight bottles of formula per day.
Warm the formula slowly by placing it in hot water. DO NOT boil the water and DO NOT use a microwave. Always test the temperature of the formula on yourself before feeding your baby.
Hold your child close to you and make eye contact. Hold the bottle so the nipple and the neck of the bottle are always filled with formula. This will help prevent your child from swallowing air.
Throw away leftover formula after a feeding. Do not keep it and use again.
O'Connor NR. Infant formula. Am Fam Physician. 2009;79:565-570.
Labiner-Wolfe J, Fein SB, Shealy KR. Infant formula - handling education and safety. Pediatrics. 2008;122 Suppl 2:S85-S90.
Heird WC. The feeding of infants and children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier;2011: chap 42.
Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital; and Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.