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Frequently Asked Questions About Formula

The benefits of a mother's milk are unparalleled -- it contains every nutrient your baby needs, is easily digested, boosts immunity, and is linked to lower rates of asthma and other chronic illnesses later in life. But some women can't nurse or choose not to, and countless others supplement the breast milk they feed their baby with formula. In all, a whopping 85 percent of new mothers use formula. Although how to bottlefeed may seem like a no-brainer, many parents have questions and concerns. The first and foremost: Is formula really okay? The experts fill us in.

1. I breastfed for four months, but my work schedule makes it too crazy to pump, so I've gradually switched over to formula. I feel guilty, though -- is formula good enough for my baby?

There's no reason to feel guilty. Some of the most intelligent, healthy people were bottlefed as infants, according to Nancy Krebs, MD, an associate professor in the department of pediatrics at the University of Colorado Health Sciences Center and the chairwoman of the American Academy of Pediatrics (AAP) nutrition committee. Although they can't pass along the resistance to infection that breast milk does, formulas do provide adequate nourishment for a growing baby. Formulas contain a comparable balance of protein and sugar and match the calorie content in mother's milk. And just like breast milk, formula gets about half its calories from fat, which is crucial to brain development. Formulas are also supplemented with various vitamins and minerals, including calcium, iron, and vitamins C, D, and K.

Of course, no infant formula exactly duplicates breast milk. Human milk is incredibly complex, notes William Klish, MD, head of gastroenterology and nutrition at Texas Children's Hospital in Houston. According to Dr. Klish, "Just being able to identify all of the ingredients in breast milk -- there are hundreds -- is a challenge. And then we don't know whether all of those substances play an important biological role or if they just happen to be there."

How to Buy Baby Formula on a Budget
How to Buy Baby Formula on a Budget

2. I've seen store-brand formulas on the shelves next to the big-name brands, and they're less expensive. Are they just as good?

There are some differences, notes Robert Baker, MD, co-chief of gastroenterology and nutrition at the Children's Hospital of Buffalo and a member of the AAP's committee on nutrition, but the generic formulas are definitely adequate. That's because all formulas sold in the U.S. must comply with minimum health standards set by the FDA. However, unlike brand-name formulas, store brands aren't continually tinkering with their recipes -- adding extra ingredients, for example, or making changes to the protein makeup or the ratio of one nutrient to another. And this tweaking, which aims to make formula more like breast milk, may add benefits in terms of baby's growth and development.

"But none of the evidence definitively states that the newer formulas are better," says Dr. Baker. So if parents are trying to save money, they can consider using the store brands.

3. I'm thinking of switching to a low-iron formula because my baby is constipated. Is that a good idea?

No. Iron deficiency is the number one nutritional deficiency in the country and the most frequent cause of anemia, a serious health condition for a child, so it's important that a baby get enough of this mineral. Pediatricians will prescribe low-iron formulas in rare circumstances; because of this, the FDA has permitted their marketing. But these products have led to suspicions -- all of which are false -- that the iron in iron-fortified infant formulas cause diarrhea, constipation, and colic. Parents then start reaching for the low-iron formulas without first consulting their pediatrician.

"There is absolutely no reason for any parent to purchase a low-iron formula unless their child's doctor calls for it," says Dr. Klish. "They are simply not nutritionally adequate." In fact, studies have shown that school-age children who were fed low-iron formula as infants tend not to do as well on standardized developmental tests as children who received iron-fortified formula.

4. I'm a vegetarian and would like to give my child a soy formula. Is it just as good as one with cow's milk?

Yes. Soy formulas are nutritionally equivalent to milk-based formulas. The soy formulas of years past were questionable because they didn't have quite the same quality of protein as cow's-milk formula, but doctors consider today's versions perfectly healthy. Babies also like soy formulas because they seem to taste a little sweeter than regular formula, adds Dr. Krebs.

5. My baby has colic. Should I switch to a different kind of formula?

Colic -- frequent inconsolable bouts of crying -- can sometimes be a sign of a milk allergy, especially if baby's crying spells and discomfort come right after feedings and he has other symptoms, including digestive difficulties and blood-tinged stool. Your pediatrician may suggest switching formulas as a way to rule out an allergy, since cow's-milk formula is the most common allergy trigger in infancy. He may recommend switching to a hypoallergenic formula, which is made with hydrolyzed, or predigested, protein. Soy formula is another alternative, but babies who are allergic to cow's milk are often allergic to soy too, so doctors may skip this option.

If you're pregnant and have a family history of serious allergies, discuss with a pediatrician whether you should put your baby on a hypoallergenic formula from the start, suggests Dr. Krebs. If your child's colic does turn out to be an allergy to cow's-milk formula, the good news is that most kids outgrow milk allergies and can tolerate regular cow's milk by the time their digestive system is mature enough for it, at age 1.

6. Is it better to use bottled water when I make formula for my baby?

You may be tempted to buy bottled water to mix with formula, but in general, tap water is safe. In fact, since there aren't clear standards for the filtering process used in bottled water's production, it may not be any better than your local tap water and could be worse, says Dr. Klish. Bottled water also lacks fluoride, important for healthy teeth, so if you use it, ask your doctor about starting baby on fluoride drops at 6 months.

Whatever kind of water you use, it's best to sterilize it first. "Bring the water to a running boil for one minute and then turn it off," says Dr. Klish. "If you let it boil for too long, concentrated salts and minerals can build up." You can stop sterilizing water once you've introduced your baby to solid food, at 4 to 6 months, since your child's system will be exposed to bacteria in real food.

When preparing formula, be sure not to add more or less water than recommended. If formula is too diluted, your baby will be undernourished; formula that's too strong can dehydrate your baby. Concentrated liquid formulas should be mixed with an equal amount of water, and powdered formulas require measuring out a specific amount of water. Ready-to-feed formulas, of course, don't require any additional water.

7. I've heard about a new supplement being added to formulas. Should I make sure to buy it for my baby?

In their quest to make formula more like breast milk, manufacturers are considering adding two polyunsaturated fatty acids, docosahexaenoic acid (DHA) and arachidonic acid (ARA) to formula. These nutrients, naturally present in breast milk and already in formulas in Europe and Japan, are important for visual acuity and in brain development.

"Infants can't make their own DHA and ARA," explains Barbara Levine, PhD, codirector of the Human Nutrition Program at Rockefeller University in New York City. "They get them through the placenta during pregnancy and from breast milk after birth." That leaves formula-fed babies at a disadvantage, but by putting DHA and ARA into formula, some experts hope to make up the difference. In recent studies, preterm babies seemed to benefit dramatically from the supplemented formula -- demonstrating better motor skills, visual acuity, and cognitive development at age 1 than preterm babies on regular formula. That's undoubtedly because preemies receive significantly less DHA and ARA in utero since they're born early. The results of studies on full-term babies are more mixed: Some have positive results similar to the preemie studies, while others don't show much of a difference. "The jury is still out," says Dr. Baker. "I'm not convinced yet that full-term babies will benefit from DHA formula." Dr. Krebs agrees: "Whether adding DHA and ARA to formula is going to produce lasting benefits five years down the line remains to be seen."

Perhaps more will be known within a year or so, when DHA formulas are projected to hit the shelves as a new (and more expensive) option.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.