Formula Feeding

Which formula do you recommend for my term baby?

Some women don’t want to or can’t breastfeed, and there are many nutritionally acceptable formula choices available on the market. In general, I recommend you give one of the regular cow milk- or soy-based formulas that contain regular (not “low”) iron. Different brands don’t differ much from each other. There is normally no reason to start with a special formula, such as “low lactose” or “hypoallergenic” formulas.

Using a soy-based formula has not been shown to protect a high-risk infant from developing allergic conditions, nor to prevent or manage “colic”.

But, if you are raising your baby as strictly vegetarian, and not breastfeeding, I do recommend a soy-based formula.

Rarely, an infant will be identified as having a metabolic disorder such as galactosemia or hereditary lactase deficiency. In these cases, a soy-protein based formula or more specialized product is necessary.

(Galactosemia is one of the conditions included in the newborn heelprick screening. If a test result is positive, the lab in Jamaica Plain will contact me urgently, usually before your baby is two weeks old. More commonly, the test specimen was inadequate for some reason. In either case, I’ll call you to make sure your baby is acting well, and I’ll ask you to allow me to order a repeat specimen right away.)

Which formula do you recommend for my preterm baby?

If your baby is born before about 35 weeks, s/he will probably spend some time in the intensive care or special care nursery. Please ask the neonatologist there whether your baby should have a preterm formula, and if so for how long.

What about the new formulas, Enfamil® Lipil™ and Similac® Advance®?

There are possible benefits for preterm babies in using formulas containing certain fats such as docosahexonoic acid (DHA) and arachidonic acid (ARA). DHA and ARA are both long chain polyunsaturated fatty acids (LC-PUFAs). The formula manufacturers are trying to make these formulas more like breastmilk. These formulas may support improved retinal and brain development compared to standard preterm formulas.

But, studies have not shown that there is an advantage in using these formulas for term babies. I think if you have a free case, go for it, but if you have to buy it and it costs more, I don’t suggest paying the extra money.

How can I tell if the formula I’m using is right for my baby?

In general, if your baby is satisfied after feeds, is growing well, and doesn’t have watery or hard stools, or mucous or blood in the stools, the formula is probably fine for him/her. Regardless of the diet you give your baby, s/he may spit up or vomit (or “reflux”) every day. That only matters if there is also crankiness during or after feeds, suggesting heartburn or bowel pain, or another complication of reflux is suspected.

When should I switch formulas?

Babies commonly spit up, cry a lot, and may have quite variable or even very infrequent stools even when they are thriving with a given formula. There are so many different formulas, and your family and friends may have ideas to help you and your baby that lead you to switch formulas. In general, give each formula a good try, for a week or more if possible. Talk to me if you are very concerned about symptoms you notice in your baby, or if you think that even after the first switch the formula is still not right.

Sometimes a baby does seem to need a “fancy” formula, such as Nutramigen®, Alimentum®, Pregestamil®, or even Neocate® (one of the most expensive ones). One of these formulas may help your baby if s/he appears to be allergic or very colicky with the more mainstream choices. Please let me see your baby before trying one of these formulas, as they are all more expensive than regular ones. If your baby is enrolled in the state’s WIC program, I need to provide medical justification for one of these formulas to be provided.

If your baby does need a “hypoallergenic” formula, s/he will probably tolerate a regular formula again by six to nine months of age.

If your baby has a prolonged diarrheal illness, especially if diarrhea improves on a rehydration solution like Pedialyte but then recurs after you resume a cow-milk based formula, then I may suggest soy formula for a week or so. Your baby’s bowel may need that time to regenerate the lactase-containing small bowel wall lining cells.

Finally, the most rare reason to switch formulas is a suspected or documented metabolic disease, such as phenylketonuria, maple syrup urine disease, or galactosemia, conditions included in the newborn screening program. The urgent need to switch to a specified formula would arise in the first days or weeks of life.

How long does my baby need to continue formula?

Please continue to provide formula until your baby is one year old. The nutrient most commonly deficient in infants and toddlers is iron, and if you substitute unmodified cow or other milks before one year, your baby is at increased risk for this problem. Iron deficiency can have a negative effect on infant brain development, and predisposes your child to lead poisoning, if there is lead in his environment.

You can provide whole milk yogurts and cheese amongst your baby’s solid foods, but your baby’s main drink (in a sippy cup, not bottle, after nine months, if possible!) should be iron-fortified formula.

By the way, checking every baby’s blood count and lead level at nine to twelve months of age is routine, and I will recommend it to you.