Formula 101: What you need to know.

by Michelle Poole RN, MA,  IBCLC

We all know that breastmilk is good stuff. Breastfeeding bestows numerous health benefits on both mom and baby, and exclusive breastfeeding was a wonderful goal to set while you were pregnant. But then the baby was born and your particular breastfeeding reality set in. And whatever the circumstances, you are now at the point where you need to or want to supplement, or perhaps you have decide to make the switch to formula. (If you haven’t already, contact an IBCLC to come up with a plan for combo feeding so that you don’t lose your breastmilk, or to wean baby from the breast as painlessly as possible.) The only problem is that because your plan was to exclusively breastfeed, you’ve learned absolutely nothing about formula. You feel lost. There are so many kinds from which to choose. I’d like to get you in the KNOW about formula, to help make this transition easier for both you and your baby. Here are five key formula facts  that will have you feeling confident about your formula choice.

  1. KNOW: All formulas are much more similar than they are different.

Scientists have been studying breastmilk for decades, and we now know the exact amounts of all the vitamins and nutrients that a baby needs to thrive. All formulas are required by federal law to meet very precise levels of proteins, fats, carbs, vitamins, and minerals at the same levels that are found in breastmilk.

So for a baby who is medically stable without any allergies or health concerns, the good news is there is no wrong formula choice. No matter which formula you buy, you can rest assured that your baby is getting everything he or she needs for on-track growth and development.

  1. KNOW: There are three main differences in formula types.

Where formulas do differ is in the sources of ingredients (A), how the ingredients are processed (B), and any additives not required for growth and development (C).

A – Formula’s main source of protein comes from either cow’s milk or soy. The protein found in dairy-based formulas is a combination of the proteins whey and casein. The level of overall protein needs to be the same across formula brands, but the ratio of whey to casein can vary drastically from formula to formula. Babies grow and thrive on all variations of the whey:casein ratio, so don’t get too caught up in the differences. Additionally, carbohydrates in dairy-based formulas come mainly from lactose, while reduced-lactose and soy formulas draw their carbs from maltodextrin, sugar, or corn syrup. Fats come in the form of various vegetable oils. Some formula companies used to use lard, but they don’t do that anymore, so baby will just have to wait to start solids to get a taste of the pork fat!

  1. In the processing of formula, manufacturers alter protein the most often and the most radically. For instance, some formulas contain “partially hydrolyzed proteins.” This means that the manufacturer reduced protein molecules into smaller elements, which they suggest makes it easier for your baby to digest. Science doesn’t strongly support any of the formula companies’ claims about anything being “more easily digestible,” but I know many moms who attest that their babies handle partially hydrolyzed protein formulas with more ease after having tummy troubles with standard formula.  If you see the word “comfort” or “gentle” on a label, that formula most likely contains partially hydrolyzed proteins.

Sugars and fats can also be processed differently, but the differences are minimal for the most part. Know that no formulas at this time contain high fructose corn syrup (HFCS) or trans-fats. You will see “corn syrup” listed as an ingredient, but it’s important to know that this corn syrup and HFCS are not the same, and plain corn syrup is nothing to be afraid of. It’s actually less sweet than real sugar, which is found in some organic formulas. Read more about the differences between corn syrup and HFCS.

There is an ongoing debate about the use of palm olein oil as a source of fat. Scientists have found that babies who consume palm olein oil tend to absorb fat and calcium at a lower rate and have a lower bone density at six months of age than babies who don’t. However, evidence also shows that once a baby starts solids, this trend is reversed, and by the time a baby is a toddler there is no longer a detectable difference in bone density. Keep in mind that the reason most formula manufacturers use palm olein oil is that it very closely resembles a main source of fat found in breastmilk. This article discusses the research concerning palm olein oil and other controversial formula ingredients.

  1. There are many special additives in formulas that are not required by federal law. Almost all formulas now contain DHA, a key fatty acid important in brain and eye development. Many formulas add pre- and pro-biotics to help with digestion issues, strengthen the immune system, and prevent constipation.
  1. KNOW: about protein allergy and lactose sensitivity.

If your baby is showing signs of formula intolerance (excessive gas, spitting up, or new fussy behaviors), rule out that this may be a bottle feeding issue (see below), and then talk to your pediatrician about switching formulas. Most formula brands offer a “reduced lactose” or “lactose free” version of their standard dairy-based formula. Lactose intolerance in infants is pretty rare, but many moms find that switching to a “sensitive” formula (i.e. lactose reduced/free formula) helps resolve their baby’s symptoms. This resolution may have nothing to do with the level of lactose, but instead be due to the different protein ratio found in these formulas.

Be aware that lactose intolerance and milk protein allergy are two separate conditions. A baby who has a true milk protein allergy will not be able to drink a lactose-free formula, as the milk proteins are still present. A baby with a milk protein allergy will show signs and symptoms including diaper rash, inconsolable crying, body rashes, irritability, vomiting, diarrhea and/or blood and mucous in stool. If your baby is showing any of these symptoms, talk to your pediatrician. Babies with a true milk protein allergy will need to drink a completely hydrolyzed formula, where proteins have been so broken down that they are unable to cause an allergic reaction. Click here to read more about the differences between lactose intolerance and milk protein allergy.

  1. KNOW: about organic formula options.

If you are an all-organic shopper, there is an organic formula on the market for you. If it makes you feel better to buy all organic, go for it, and know there are nutritional organic choices for your baby. Likewise, if you are a non-organic shopper, or an “I would be an all organic shopper if I could afford it” kind of mom, understand that there is no reliable evidence that an organic formula is any better for your baby than a non-organic formula. So buy whichever formula works best for your baby (and your wallet) and know that it is a nutritionally sound choice. Something else to keep in mind: Some organic formula makers advertise that “no pesticides” and “no high fructose corn syrup” are found in their products, when in reality, non-organic formulas don’t contain these things either.

GMOs are a hot topic today, especially with concerned mothers, and you should know that there have been no detectable differences found between GMO foods and foods claiming to be non-GMO.

Many mothers worry about the hormone levels in non-organic cow’s milk, but it’s important to understand then when talking about baby formula, the non-organic milk is so thoroughly processed that no traces of hormones have ever been detected in standard infant formula.

If you are still wondering whether you should choose an organic formula, this article can help you make an even more informed decision.

  1. KNOW: How you feed your baby is just as important as what you feed your baby.

Use a paced bottle feeding technique to avoid excess gas, digestion issues, and overfeeding.

So, do you feel better about buying formula? Before you head out to the store, remember first and foremost that that there is no wrong choice here, as long as you have a full term healthy baby who is not prone to allergies. And always talk to your pediatrician before making any changes.

If your baby will still be getting breastmilk, I’d recommend looking into a formula designed for supplementation. All three of the large formula companies offer their version of a supplementation formula, which contains prebiotics and the aforementioned partially hydrolyzed proteins.  This type of formula may make baby’s transition from breast to bottle easier on his or her belly.  All supplementation formulas also contain slightly higher levels of vitamin D than standard formula, under the formula companies’ (probably correct) assumption that your baby is not getting quite enough. While I can’t come out and recommend a particular brand of formula, I have narrowed your choice down from about 75 options to 3, so hopefully this helps!  Go to the formula companies’ websites to learn more about these choices.

If you are making the switch to all formula, you’re probably already using a particular type.  If it’s been going down well, carry on with it as you now know that it is a nutritionally sound choice.  If you are looking to switch, consider what you’ve learned here and then talk to your pediatrician about what formula he or she would recommend given your particular circumstances.  If you haven’t tried a formula yet, feel good about using free samples or coupons to try one out. If your baby has been prone to gas or other tummy troubles even while drinking breastmilk, consider a formula containing those “gentle” or “comfort” proteins to start.

The world of formula shopping can be overwhelming and sometimes emotionally charged, especially for a mom who wasn’t planning on supplementation. I hope that this guide has given you a little more knowledge about what you’re buying and how to shop, and that you feel okay about your ultimate decision.

I want to leave you with one more “know.”

Know this:  If you love your baby and you feed your baby, whether by bottle, boob, or both, you are an awesome mom and your baby thinks you are the best!


About Michelle:

Michelle was inspired to help women breastfeed after overcoming early feeding difficulties with her son, Riley.  Michelle started as a volunteer breastfeeding counselor with the Nursing Mother’s Alliance in 2011.  She worked as a lactation intern at A.I. duPont Hospital for Children and The Chester County Hospital before joining The Birth Center as a Lactation Consultant in the summer of 2014.  Michelle received her Master’s Degree in Counseling in 2002 and graduated from nursing school in 2014.  Her certification as an International Board Certified Lactation consultant was awarded in 2014.

“I enjoy being part of a team who truly values each woman’s individual goals for birthing and breastfeeding. I will do my best to provide education, encouragement, and support that will get you to where you want to be!”

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