Frequently Asked Questions About Formula
Whether you're switching between breastfeeding and formula or considering switching formula brands, experts weigh in to make sure your baby gets all the nutrition he needs.
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. 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, M.D., a pediatric gastroenterologist affiliated with the department of pediatrics at the University of Colorado Health Sciences Center. 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, M.D., 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."
2. What about the supplements being added to formulas? Do they help make formula more comparable to breastmilk?
Some studies suggest that infants who are breastfed may have slightly better brain and eye function than infants who are formula fed, explains Amy Lynn Stockhausen, M.D., an associate professor of general pediatrics and adolescent medicine at the University of Wisconsin School of Medicine and Public Health, but she adds that the differences are small and the research is not consistent or clear in terms of whether this is surely true, or how it might work. Two long-chain polyunsaturated fatty acids, docosahexaenoic acid (DHA) and arachidonic acid (ARA), found in breastmilk are credited in the structure and function of human tissues, immune function, and brain and retinal development during gestation and infancy, according to a study published by the National Institutes of Health. While our bodies do make DHA and ARA, the study says that growing infants cannot maintain necessary levels of these fatty acids without supplementation.
"Formula companies are now adding DHA and ARA to formula in an effort to mimic breast milk, in hopes that it will provide benefit to formula-fed infants similar to breastfed infants," says Dr. Stockhausen. "So far, there is no good research that shows clear benefits from adding DHA or ARA to formula, but it is generally recognized as safe by the FDA and does not appear to have harmful side effects. It’s hard to find formulas these days that do not have these compounds added to them because they are so popular in the formula market; while we think they are safe, they may or may not provide any actual benefit."
3. 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, M.D., 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.
4. I'm thinking of switching to a low-iron formula because my baby is constipated. Is that a good idea?
Low-iron formulas are no longer commercially available in the United States, and for good reason. 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. Some parents think that iron in formula is the cause of their infant's tummy issues, but Dr. Stockhausen says that's not likely. "There is not enough iron in infant formula to be the cause of stomach upset or constipation for most healthy infants, and the risk of iron deficiency with the low-iron formulas was concerning enough concern that the low-iron formulas were taken off the market," she said.
5. I'm a vegan 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 cow milk-based formulas, according to the American Academy of Pediatrics. They recommend using soy formula for term infants with galactosemia, hereditary lactase deficiency, documented immunoglobulin E-associated allergy to cow milk who are not also allergic to soy protein, or parents seeking a vegetarian-based diet for their term infant.
However, soy protein-based formula is not recommended for preterm infants with a birth weight less than 1800g, prevention of colic, or infants with cow milk protein-induced enterocolitis or enteropathy. In these cases, as your pediatrician for appropriate formula alternatives.
6. My baby has stomach problems, like gas or constipation. Should I switch to a different kind of formula?
"For babies with gassy tummies, hard or pasty stools, or digestive upset with formula, it may be helpful to try a formula that has the milk proteins partially broken down already, which for some babies can make them easier to digest, says Dr. Stockhausen. "These are often labeled as “gentle”, and often also contain less lactose than regular formulas. For some babies it may also be useful to look for a formula that contains probiotics, as some recent research suggests that probiotics can be helpful to aid in digestion for fussy infants, and are generally considered safe in this context. If trying a product like this does not help, or if there is forceful vomiting, stools that are watery or that contain blood or mucus, or if Baby is very fussy throughout the day and night, then it’s time to call the doctor."
7. 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 the 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.