Infant formulas

There are different formulas available for infants younger than 12 months old who are not drinking breast milk. While there are some differences, infant formulas sold in the United States have all the nutrients babies need to grow and thrive.

TYPES OF FORMULAS

Babies need iron in their diet. It's best to use a formula fortified with iron, unless your child's health care provider says not to.

Standard cow's milk-based formulas:

• Almost all babies do well on cow's milk-based formulas.
• These formulas are made with cow's milk protein that has been changed to be more like breast milk. They contain lactose (a type of sugar in milk) and minerals from the cow's milk.
• Vegetable oils, plus other minerals and vitamins are also in the formula.
• Fussiness and colic are common problems for all babies. Most of the time, cow's milk formulas are not the cause of these symptoms. This means that you likely do not need to switch to a different formula if your baby is fussy. If you're not sure, talk with your infant's provider.

Soy-based formulas:

• These formulas are made using soy proteins. They do not contain lactose.
• The American Academy of Pediatrics (AAP) suggests using cow's milk-based formulas when possible rather than soy-based formulas.
• For parents who do not want their child to eat animal protein, the AAP recommends breastfeeding. Soy-based formulas are also an option.
• Soy-based formulas have NOT been proven to help with milk allergies or colic. Babies who are allergic to cow's milk may also be allergic to soy milk.
• Soy-based formulas should be used for infants with galactosemia, a rare condition. These formulas can also be used for babies who can't digest lactose, which is uncommon in children younger than 12 months.

Partially hydrolyzed formula:

• Formula in which milk protein has been broken down into smaller pieces which in theory makes it easier to digest
• Commonly used for infants that are formula fed that are experiencing gas, fussiness, and crying
• Some of these formulas also may have a reduced amount of lactose as compared to cow's milk formula

Hypoallergenic formulas (protein hydrolysate formulas):

• This type of formula may be helpful for infants who have allergies to milk protein and for those with skin rashes or wheezing caused by allergies.
• Hypoallergenic formulas are generally much more expensive than regular formulas.

Lactose-free formulas:

• These formulas are also used for galactosemia and for children who can't digest lactose.
• A child who has an illness with diarrhea usually will not need lactose-free formula.

There are special formulas for babies with certain health problems. Your pediatrician will let you know if your baby needs a special formula. DO NOT give these unless your pediatrician recommends it.

• Reflux formulas are pre-thickened with rice starch. They are usually needed only for infants with reflux who are not gaining weight or who are very uncomfortable.
• Formulas for premature and low-birth-weight infants have extra calories and minerals to meet the needs of these infants.
• Special formulas may be used for infants with heart disease, malabsorption syndromes, and problems digesting fat or processing certain amino acids.

Newer formulas with no clear role:

• Toddler formulas are offered as added nutrition for toddlers who are picky eaters. To date, they have not been shown to be better than whole milk and multivitamins. They are also expensive.

Most formulas can be purchased in the following forms:

• Ready-to-use formulas -- do not need to add water; are convenient, but cost more.
• Concentrated liquid formulas -- need to be mixed with water, cost less.
• Powdered formulas -- must be mixed with water, cost the least.

Formula feeding; Bottle feeding; Newborn care - infant formula; Neonatal care - infant formula

American Academy of Pediatrics website. Amount and schedule of baby formula feedings. www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/Amount-and-Schedule-of-Formula-Feedings.aspx. Updated May 16, 2022. Accessed May 29, 2023.

Parks EP, Shaikhkhalil A, Sainath NN, Mitchell JA, Brownell JN, Stallings VA. Feeding healthy infants, children, and adolescents. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 56.

Seery A. Normal infant feeding. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2023. Philadelphia, PA: Elsevier 2023:1340-1347.

Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.