Choosing the right baby formula

Whether you're planning to exclusively rely on formula to feed your baby, combine breastmilk and formula, or simply want to have formula as a backup, the array of options available can be overwhelming. It's important to note that while there may not be a single "perfect" infant formula, there is likely a formula that will suit your baby's unique needs. Here, we provide comprehensive information to help you make the best choice for your little one when it comes to baby formula.

What is infant formula? While the American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first 6 months of a baby's life, it's not always feasible or suitable for everyone. This is where baby formula comes into play. Infant formula serves as a partial or complete substitute for breastmilk for babies under 12 months old. During this critical growth period, babies experience a threefold increase in size, leading to increased nutritional demands. To ensure that all infant formulas meet specific federal nutrition guidelines, the Food and Drug Administration (FDA) regulates the content of all infant formulas sold in the United States.

Fun Fact: Infant formula was first developed by a chemist in 1865 and consisted of cow's milk, wheat and malt flour, and potassium bicarbonate.

What's in baby formula? Despite variations in labels, colors, and prices, all infant formulas must contain specific amounts of calories, carbohydrates, protein, fats, vitamins, and minerals. Here's a breakdown of what you'll find in all infant formulas on the market:

• Calories: Babies need a substantial amount of calories for healthy brain development. Typically, baby formulas provide 19 to 20 calories per ounce.
• Carbohydrates: Carbohydrates are a primary energy source for your baby and can be derived from corn syrup solids, maltodextrin, sucrose, or lactose, which is the natural sugar found in breastmilk.
• Protein: Protein is essential for the growth of baby hairs, tiny fingernails, and the development of cells, hair, skin, and organs. Baby formula sources protein from nonfat milk, milk protein isolate, whey, casein, soy, and amino acids.
• Fats: Fats play a crucial role in healthy growth and development and can be labeled as vegetable oil, palm olein oil, coconut oil, canola oil, or corn oil in baby formula.
• Vitamins and minerals: Baby formulas are fortified with essential nutrients such as vitamins A, D, K, C, choline, calcium, and iron to prevent deficiencies and promote a healthy start. All infant formulas must contain at least 29 different nutrients, with specific maximum limits for nine of those nutrients. However, there are exceptions for "special care" infant formulas designed for preemies, those with metabolic issues, and amino acid-based formulas. If you're not breastfeeding at all, it's recommended to provide your baby with an iron-fortified formula containing 4 to 12 milligrams of iron during the first year.

In addition to these essentials, some baby formulas may include:

• Long-chain fatty acids: Docosahexaenoic acid (DHA) and arachidonic acid (ARA), which are two long-chain fatty acids found in breastmilk. While the AAP recognizes their importance for early brain development, studies have not universally confirmed their benefits in infant formula.
• Probiotics and prebiotics: Probiotics are beneficial live bacteria, while prebiotics are substances that nourish probiotics. Both are generally good for gut health, but there's limited evidence supporting their efficacy in baby formula, according to the AAP.
• Human milk oligosaccharides: These naturally occurring compounds in breastmilk help protect against infections. Research suggests that when breastmilk is unavailable, infant formula supplemented with HMOs may serve as an alternative.
• Lutein: Lutein is a carotenoid with antioxidant properties naturally present in breastmilk, promoting eye health and cognitive development. The impact of adding lutein to baby formula is still unclear, as infants seem to absorb more lutein when nursing than from fortified formula.

What Types of Baby Formula are Available? Beyond the basic categories of powdered, concentrate, and liquid formulas, several distinct types of baby formula are available today. Each type is considered suitable for infant consumption, but they have specific differences:

Cow's Milk-Based Infant Formula: Regular cow's milk is not suitable for infants under 12 months old, but cow's milk-based infant formula is carefully manufactured to ensure it is safe and digestible. Like breastmilk, cow's milk infant formula contains lactose, a milk sugar. Some sensitive or gentle formulas have reduced levels of lactose for babies with lactose sensitivity. Currently, cow's milk-based infant formula comprises 80% of the market, and most babies tolerate it well. However, some infants may have cow's milk protein allergy (CMPA), which can lead to skin issues, digestive problems, and even breathing difficulties.

Fun Fact: In the 1930s and 1940s, pediatricians used to recommend condensed milk as an infant food.

Soy Infant Formula: Soy-based baby formula is free of lactose and cow's milk protein, making it a necessary choice for babies born with a rare condition known as galactosemia, which prevents them from tolerating lactose. It's important to note that many babies may experience temporary lactose intolerance, but significant lactose issues are extremely rare in infants, according to the AAP. While some believe that soy formula can help alleviate colic symptoms, there is limited evidence supporting this claim. Generally, there are few situations in which soy formula is preferred over cow's milk-based formula, as noted by the AAP.

Fun Fact: The first soy-based infant formula became available to the public in 1929, but it lacked important vitamins and nutrients.

Hydrolyzed and Partially Hydrolyzed Infant Formula: Hydrolyzed and partially hydrolyzed formulas are named after the size of their protein molecules. Cow's milk-based baby formula typically contains large and intact proteins, which can be difficult for some babies to digest. In such cases, babies may require an infant formula with smaller protein molecules. Partially hydrolyzed formulas have proteins that are partially broken down, which may help reduce gassiness. Fully hydrolyzed baby formula goes a step further, breaking down proteins even more, and is best suited for babies with more severe issues like cow's milk protein allergy or multiple food allergies.

Fun Fact: These types of infant formulas are often referred to as "predigested" because the proteins are already broken down into smaller units.

Organic Baby Formula: For a baby formula to be certified as "organic" by the U.S. Department of Agriculture, at least 95% of the listed ingredients must be organic. This means that if it's a cow's milk organic infant formula, it must come from cows that have consumed an organic diet. For plant-based formulas, the plant source must have limited exposure to pesticides and be free of genetically modified organisms. While organic formulas tend to be more expensive, there is no concrete evidence to suggest that they offer any advantages over non-organic formulas with equivalent nutrition and safety.

Fun Fact: "Organic" does not imply that your baby formula is entirely natural, as certain nutrients and preservatives must be synthetically created.

Special Infant Formula: There are additional types of infant formulas designed to meet the specific needs of infants with medical conditions or those born prematurely. If your baby