Choosing Formula: A Primer

I'm bottle-feeding my baby. Which formula is best?

It's easy to feel overwhelmed in the formula aisle. Choosing the best nourishment for your baby is a pretty weighty decision, and there are lots of choices. When choosing a formula, you'll want to consider the form it comes in (ready-made, concentrate, or powdered), the type of protein it uses (cow's-milk-based formula is the most popular, but there are other options), and what other ingredients are included (such as DHA and iron). Here's what you need to know:

Forms of formula
Formulas come in three basic forms: ready-made, concentrate, and powdered.

Ready-to-use formula is undoubtedly the most convenient — no mixing or measuring required, just open and serve. It's hygienic and especially helpful in circumstances where you might not have access to safe water. It's also a good choice if your baby was born with a very low birth weight or is otherwise immuno-compromised, because it's sterile. But for everyday use, the convenience of ready-to-use formula comes at a price — ready-to-use formula costs about 25 percent more per ounce than powdered formula. The containers also take up more storage space in your cupboard and more space in the landfill, unless you can recycle all of the cans or bottles. Once opened, ready-to-use formula has a short lifespan — it must be used within 48 hours. Also, because it often has a darker color than powdered formula, many moms complain that it's more likely to stain clothes.

Liquid concentrate formula requires you to mix equal parts of water and formula, so read the instructions on the container carefully. Compared to ready-to-use formula, concentrate is less expensive and takes up less storage space. Compared to powdered formula, it's a little easier to prepare but more expensive.

Powdered formula is the most economical choice and the most environmentally friendly. It takes up the least amount of space in transport, in your pantry, and in your trash can. Powdered formula takes more time to prepare than other types of formula, and you must follow the directions exactly, but it has a one-month shelf life after the container has been opened. Besides, you can mix up just the right amount whenever you need it — as much or as little as you want — which is especially helpful if you're a breastfeeding mom who may only need an occasional supplemental bottle for your baby.

Types of formula
There's a formula to suit every baby's needs.

Cow's-milk-based formula: Most formula available today has cow's milk as its main ingredient. The protein in the milk is significantly altered to make it easier to digest, because your baby won't be ready to digest regular cow's milk until after his first birthday.

Soy-based formula: If you're avegan, or if your baby has trouble digesting cow's milk protein, the doctor may suggest a soy-based formula. These are made with a plant protein that, like the protein in cow's milk, is modified for easy digestion by babies. You may also want to talk with your baby's doctor about giving soy-based formula a try if your baby has colic. The evidence isn't conclusive, but some research suggests it's worth a try.

Lactose-free formula: If your baby is lactose-intolerant, or unable to digest lactose, which is the sugar naturally found in milk, his doctor will recommend a lactose-free formula in which the lactose is replaced with a different sugar, such as corn syrup.

Extensively hydrolyzed formula: In these formulas, the protein is broken down into smaller parts that are easier for your baby to digest than larger protein molecules. Your baby may need a hydrolyzed formula if he has allergies or trouble absorbing nutrients. The doctor may also suggest trying a hydrolyzed formula if your baby has colic.

Formulas for premature and low-birth-weight babies: These formulas often contain more calories and protein, as well as a more easily absorbed type of fat called medium-chain triglycerides.

Human milk fortifier: This product is used to enrich the nutrition of breastfed babies who have special needs. Some are designed to be mixed with breast milk, and some can also be fed alternately with breast milk.

Metabolic formulas: If your baby has a disease that requires very specialized nutrition, he may need one of these specially developed formulas.

What's in formula? How do formulas differ?
There are six main ingredients in formula: carbohydrate, fat, protein, vitamins, minerals, and other nutrients. What makes one brand of formula different from the next is the specific carbohydrate or protein it uses, as well as any additional ingredients it includes. For example, casein and whey are two kinds of cow's milk proteins that are found in various proportions among different brands of cow's-milk-based formula.

It's very easy to get confused by all of the items listed on the ingredient label. Below, we guide you through the maze of ingredients, and compare them to those found in breast milk.

Carbohydrate: Lactose is the main carbohydrate source in breast milk, and it is also the primary carbohydrate source in cow's-milk-based formulas. Corn maltodextrin is sometimes used as a secondary source of carbohydrate. Lactose-free, soy, and special formulas contain one or more of the following carbohydrates: sucrose, corn maltodextrin, modified cornstarch, or corn syrup solids.

Protein: Breast milk contains about 60 percent whey and 40 percent casein. Most formulas have similar protein content. Others contain 100 percent whey. Some studies indicate that whey protein is digested faster than casein, which could be beneficial for babies with gastroesophageal reflux disease (GERD).

Soy formulas contain soy protein isolate. Some brands use partially hydrolyzed soy protein to encourage easier digestion.

Sometimes the protein in formula is partially hydrolyzed, or broken down. Partially hydrolyzed formulas are not hypoallergenic — don't use one if your baby has a protein allergy, or even if you suspect he may have one. However, partially hydrolyzed whey formulas have been shown in one study to reduce atopic dermatitis, compared to standard cow's-milk formula.

Extensively hydrolyzed formulas contain extensively broken-down casein with additional amino acids, which are the building blocks of protein. These formulas are considered hypoallergenic and are used for babies who have a protein allergy.

Fat: Breast milk contains a blend of monounsaturated, polyunsaturated, and saturated fat. Formulas use a variety of oils to match the fat makeup of breast milk. They include soy oil, coconut oil, corn oil, palm or palm olein oil, and high oleic sunflower oil. Although palm and palm-olein oil are widely used, research has shown that these fats can reduce absorption of fat and calcium from formula. In other words, your baby may not absorb as much fat and calcium as he would from a formula that doesn't contain these oils.

Medium-chain triglycerides require less effort to digest and are more easily absorbed. They're used in special formulas for premature infants and for infants who have trouble digesting or absorbing nutrients.

The FDA has approved the addition of two long-chain fatty acids to formula: DHA (docosahexaenoic acid) and ARA (arachidonic acid). Both of these substances are found in breast milk when the mother's diet is adequate, and both are important for brain and vision development. Babies get DHA and ARA from their mother during the third trimester, but the transfer is cut short when a baby is born prematurely. All babies need a continuing supply of both substances throughout their first year.

Two studies published in April 2005 support the supplementation of formula with DHA and ARA. One, a report published in the American Journal of Clinical Nutrition, showed that full-term infants fed DHA- and ARA-supplemented formula had significantly better visual acuity than infants who did not receive the supplements. And a study published in The Journal of Pediatrics states that DHA and ARA enhance both cognitive and physical growth in preterm infants.

There aren't any long-term studies confirming the safety of these substances, although there's no evidence suggesting that these additives are harmful to babies, either. Formulas that include DHA and ARA are priced about 15 percent higher than standard formula. The American Academy of Pediatrics (AAP) has not taken a position on whether these fatty acids should be added to formula.

Vitamins and minerals: The majority of words on the ingredient label describe vitamins and minerals. These words can be hard to figure out — ferrous sulfate is iron, for example, sodium ascorbate is vitamin C, and calcium pantothenate is a B vitamin.

The AAP recommends that all healthy babies who aren't breastfed exclusively be given iron-fortified formula until they reach their first birthday. It's important that babies receive the minimum recommended amount of iron (4 mg of iron per liter) to prevent iron-deficiency anemia.

Anemia inhibits the blood's ability to circulate oxygen, which all of the body's cells need to function properly. Studies have shown that getting enough iron in the first year of life is important for success in school later on. A baby's iron stores are established in the last trimester, so it's especially important for premature babies to get plenty of iron.

Most formulas contain at least 4 mg of iron per liter, although "low-iron" formulas are still on the shelves. These were developed years ago in response to the misconception that iron causes constipation. The AAP would like these low-iron formulas to be discontinued or labeled as nutritionally inadequate.

Other ingredients Here's where the different brands tweak their formulas to make them stand apart from one another.

Nucleotides: These are the building blocks of DNA and RNA, naturally present in breast milk. They have several functions and may aid in immune system development. Different brands of formula have different amounts of nucleotides added.

Rice starch: Rice starch is added to "anti-regurgitation" formula. Some research shows the pre-thickened formula does result in less spitting up and choking. However, other research indicates there may be the same amount of acid reflux regardless. Ask your baby's doctor before using an "AR" formula to help with your baby's spitting up.

Dietary fiber: Soy fiber is added to soy formula for the temporary treatment of diarrhea. The only formula containing fiber is Isomil DF, which is clinically shown to reduce the duration of diarrhea.

Amino acids: Amino acids such as taurine, methionine, and carnitine are added to soy formulas, and sometimes to cow's-milk formulas, to match the amount of amino acids in breast milk.

"Designer" formula: This formula is unique in that it has a protein ratio similar to breast milk, but the proteins are partially broken down to aid digestion. It also has 25 percent less lactose than regular formula.

Are generic brands nutritionally adequate?
Generic brands of formula must meet requirements from the federal Food and Drug Administration (FDA) for nutrients in formula, so in many instances, the only difference between generic and brand name is the price. Whether you're buying generic or name brand, though, take a minute to look at the label before you purchase the formula. Specific ingredients do vary from brand to brand, and this can make a difference to your baby.

Can I make my own formula?
No. It would be impossible to include all of the ingredients in the right amounts for your baby. Homemade formula could lead to failure to gain weight, malnourishment, or even death.

What about adding cereal or milk to my baby's formula?
Never add vitamins, cereal, fatty acids, olive oil, regular cow's milk, or any other ingredients to your baby's formula unless your doctor recommends it. Formula is a carefully developed substance with precise amounts of dozens of nutrients. Adding anything to formula could jeopardize your baby's health.

Olive oil, for example, can lead to permanent lung damage and even death, because of the danger of inhaling the oil into the lungs when spitting up. Because cow's milk is so hard for babies to digest, never mix cow's milk with formula or give it to your baby straight until he's at least 1 year old. And adding breast milk to formula is a waste of breast milk if your baby doesn't drink the entire bottle.

What if I'm still not sure?
If you've decided to feed your baby formula and you're still baffled by the many options available, or you're considering switching formulas, talk with your baby's doctor. She'll consider your baby's health, age, and nutritional needs and make an appropriate recommendation. She can also monitor your baby's reactions and investigate any symptoms. Don't try to diagnose an allergy or sensitivity on your own. You could miss a serious underlying condition or prevent your baby from getting adequate nutrition.

source from http://www.babycenter.com