While 96% of Australian mothers intend to breastfeed, 34% of babies have been given formula in their first month, and by 6 months, almost 70% of babies have been introduced to formula, either partially or fully.
Many new parents aren't aware of the different types of formula.
If you live in an area where formula samples are common, you might select a formula brand and type based solely on having a sample handy.
Does it really matter what brand of formula you choose?
Is the type of formula you select an important decision?
Whether your baby is mixed-fed or fully formula fed, you need to use an appropriate breastmilk substitute until twelve months of age.
While the range of products on supermarket shelves can seem overwhelming, the differences between brands are minimal.
The type of formula is more important.
Choosing Baby Formula
Here are 5 facts to help you choose the right baby formula for your baby:
#1: Cow's Milk Formula Has Many Additives – Protein Content Is Important
Cow’s milk is obviously designed for baby cows. But by adjusting the amounts and types of proteins, fat and carbohydrates, it makes cows milk an appropriate human milk substitute.
Extra iron and vitamins are added, to help it meet a human baby’s nutritional needs.
But there are many other components of human milk which cannot be reproduced in formula.
Your mother or grandmother might tell you they fed their babies on Carnation or other brands of tinned milk. Or perhaps the nurse wrote out a recipe for them to mix their own baby formula at home, based on cow’s milk.
We now know a lot of babies became sick or malnourished from that type of feeding, and it's no longer recommended.
Modern commercial formulas contain many more important ingredients than past tinned milk formula recipes.
How Much Protein Do Babies Need – And Why Is It Important?
There is evidence that excessive protein intake in the first two years of an infant's life — potentially through baby formula — could be contributing to childhood obesity. Some infant formula brands have a much higher protein content than breastmilk.
It's recommended that infants up to six months old have about 10 grams of protein per day, which is in line with what would be consumed through breastmilk. The Australian Dietary Guidelines, revised in 2012, say that a lower protein formula should be chosen. When you look at the nutritional panel on the formula packaging, look at the protein content per 100ml, and choose a formula which has the lowest protein count per 100ml.
#2: Understanding The Labelling Is Also Important
Because formula manufacturers are basically trying to sell you the exact same product, they are keen to be the first on the market with any new ingredients which research suggests are important in breastmilk (or might help with your baby’s health or development). It can become pretty confusing to work out what all the claims on the labels mean, so here are some of the most common:
Probiotics & Prebiotics
Probiotics are ‘good’ bacteria and may help keep your baby’s digestive system healthy. Prebiotics create an environment to help the good bacteria grow. Prebiotics and probiotics are naturally found in breastmilk, and some of the strains may be added to infant formula during manufacture.
The most common types of probiotics are strains of tiny organisms called Bifidobacterium and Lactobacillus.
Some research has suggested that these probiotics may prevent or treat disorders such as infectious diarrhoea and atopic dermatitis (eczema) in children. Other research is investigating whether probiotics can lower your child's risk of food-related allergies and asthma, prevent urinary tract infections, or improve the symptoms of infant colic. At this time, any benefits appear to occur only as long as the probiotics are being taken. More research is needed to see if there are any long-term benefits.
Gold formulas have certain types of fats – long-chain polyunsaturated fatty acids (LCPUFAs) – added to them. These are thought to be important in the development of the brain and eyes. Breastmilk naturally contains LCPUFAs (especially DHA and AA). It isn’t known if these added fats in formula work in the same way as those naturally found in breastmilk, or if they are absorbed as effectively.
#3: Special Needs Formulas
Some babies have health issues which make standard infant formula unsuitable for them. Although some are available without prescription, it's important to only use them with medical advice. A proper diagnosis and treatment plan needs to be put into place.
‘AR’ means anti-regurgitation.
If your baby has reflux, it might be suggested you use a special formula which is thickened. It's important to seek your doctor’s advice if you suspect your baby has gastro-oesophageal reflux or ‘GOR'.
Thickened formulas may reduce frequency and volume of regurgitation (vomiting), but won’t affect pain from oesophagitis (feed refusal and irritability).
Not all babies are helped by thickened feeds, and some might require medication.
HA/Partially Hydrolysed Infant Formula
‘HA’ means hypo-allergenic.
If your baby has a high risk of allergies and is not able to be breastfed, then hypo-allergenic formula might be considered. In HA formula, the proteins in the milk have been broken down into smaller parts.
These products are NOT suitable for babies with a diagnosed allergy to cow’s milk, which affects about 2% of infants under two years of age.
Extensively Hydrolysed Formula (EHF)
This is cow’s milk based formula that has been treated with enzymes to break down most of the proteins that cause symptoms. This is the first choice for babies with a diagnosed cow’s milk allergy.
Amino Acid Formula (AAF)
This formula is necessary for around 10 percent of children with cow's milk allergy. This formula will be tolerated by almost all children with soy or cow's milk allergies.
Many babies with cow’s milk allergy are also allergic to soy milk, so it's important to consult your doctor before using it. Although labelled as suitable from birth, many health professionals only recommend soy formula for babies aged 6-12 months.
There is no evidence that changing to soy formula will help with colic or reflux. If lactose intolerance is suspected, a lactose-free formula is preferred.
Not only are there no recognised benefits to soy formula, there is some concerns about them. Soy contains high levels of oestrogen-like substances, called phytoestrogens, which might affect a child’s hormonal development. Additionally, the glucose syrup which artificially sweetens soy formula could be damaging to your baby’s teeth.
It has been suggested that the use of soy-based formulas be limited to those infants with a rare medical condition (galactosemia) or those who cannot consume dairy-based products for cultural or religious reasons.
Lactose intolerance happens when the body can’t break down a sugar called lactose. Lactose is present in breastmilk, all animal milks and other dairy products, as well as milk-based formula.
Lactose intolerance is different to cow’s milk allergy.
Primary (or true) lactose intolerance is an extremely rare genetic condition. A truly lactose-intolerant baby would fail to thrive from birth, and will show obvious symptoms of malabsorption and dehydration. This would be recognised by medical care providers, and the baby put on a special diet immediately.
Secondary lactose intolerance is the more common condition that people are aware of. The enzyme lactase, which breaks down lactose in the digestive system, is produced in the very tips of the microscopic folds of the intestine. Anything that damages the gut lining can cause temporary lactose intolerance, for example gastroenteritis.
Sometimes lactose intolerance is confused with other digestive problems, such as a food allergy or lactose overload. This is because these conditions have similar symptoms. Food allergies and lactose overload aren’t the same as lactose intolerance, and don’t affect a baby’s production of lactase.
If you doctor suspects lactose intolerance in your formula fed baby, you will be advised to change to a lactose free formula. This might sometimes also be suggested for a breastfed baby showing signs of lactose intolerance, however weaning is not always necessary.
Here are 4 facts about lactose intolerance.
#4: Organic Formula – Is It Different Than Conventional?
Many families turn to organic infant formula, thinking it'll be the healthiest alternative when breastfeeding doesn’t work out.
So, how do they measure up compared to the standard products?
In Australia, all formulas are all made to have around the same amount of energy (calories or kilojoules), protein, fats, carbohydrates, vitamins and minerals. This includes those labelled as organic. What makes them different is how the base ingredients have been farmed: the properties where the cows are raised and milked, and the vegetables for oils grown need to meet the criteria to be Certified Organic.
However, just because a product says it has been grown organically doesn’t mean that there are no chemicals involved at any point in the manufacturing process. So doing your research is important to make sure the entire process, from paddock to plate, is what it says it is.
Keep in mind too, the country of origin and how certification standards may vary – this is important, as many products are imported. If your baby requires a special needs formula, you may find organic options limited or non-existent.
#5: Ages and Stages Formulas Aren't A Necessity
Starter formula or ‘step one' is recommended for babies under six months.
But what about steps 2 and 3 – also known as follow-on formula and toddler formula? Does your baby need them?
You might be surprised to learn the general opinion from the medical community is – NO!
It turns out ‘starter’, ‘newborn’ or ‘step 1’ formula can be used from birth until 12 months of age, and it gives your baby everything she needs in a formula.
The baby feeding industry invented follow-up and toddler formulas for marketing purposes, in an effort to get around advertising restrictions in some countries.
You can learn more in Toddler Formula – 7 Things You Need To Know.
There is much that needs to be done to enable all mothers reach their personal breastfeeding goals. Where overwhelming problems lead to premature weaning, and for those families who choose not to initiate or continue breastfeeding in the first year, access to the right infant formula is important.
You might also like to read When Breastfeeding Doesn’t Work Out – 9 Tips To Help and if you are still considering your options, this article might be helpful: 8 Things To Know Before You Give Up Breastfeeding.