Infant formulas - overview
Formula feeding; Bottle feeding; Newborn care - infant formula; Neonatal care - infant formula
During the first 4 to 6 months of life, infants need only breast milk or formula to meet all their nutritional needs. Infant formulas include powders, concentrated liquids, and ready-to-use forms.
Food Sources
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.
Deciding to feed your baby breast milk or formula is a personal matter. If you do choose formula, it's designed to be a nutritional source of food for infants. Let's talk about infant formula. A variety of formulas are available for infants younger than 12 months old. Infant formulas vary in nutrients, calorie count, taste, ability to be digested, and cost. Standard milk-based formulas are made with cow's milk protein that has been changed to be more like breast milk. These formulas contain lactose and minerals from cow's milk, along with vegetable oils, minerals, and vitamins. Soy-based formulas are made using soy proteins. These formulas are useful when parents do not want their child to eat animal protein, or the child has a rare metabolic problem and can't tolerate other formulas. Also, soy formulas do not contain lactose. Other lactose-free formulas are available to help babies with lactose problems. Hypoallergenic formulas may be helpful for babies who have true allergies to milk protein. They can also help babies with skin rashes. One caveat you'll pay a lot more for them. Your baby's doctor may recommend other special formulas. Reflux formulas are pre-thickened with rice starch. They can help babies with reflux problems who are not gaining weight. Formulas for premature and low-birth weight infants have extra calories and minerals. Other special formulas are available for babies with heart disease and digestion problems. So, what's the best way to take care of infant formula and bottles? You'll need to clean bottles and nipples with soap, then for very young babies boil them in a covered pan for 10 minutes. Once the bottles are cooled, you can make enough formula to last 24 hours. Make it exactly as the package directs you to. Once you make formula, store it in your refrigerator in individual bottles. During the first month, your baby may need at least 8 bottles of formula a day. When it's time to feed your baby, warm the formula slowly in hot water. Always test the temperature of the formula before feeding your baby. Hold your child close to you and make eye contact. Hold the bottle so the nipple and neck of the bottle are always filled with liquid. This helps prevent your child from swallowing air, which can cause gas and vomiting. Once you're finished feeding your baby, throw away any formula left in the bottle. Children should get breast milk or formula at least throughout the first year. This is the centerpiece of infant nutrition.
Recommendations
The AAP recommends that all infants be fed breast milk or iron-fortified formula for at least 12 months.
Your baby will have a slightly different feeding pattern, depending on whetherthey are breastfed or formula fed.
In general, breastfed babies tend to eat more often.
Formula-fed babies may need to eat about 6 to 8 times per day.
- Start newborns with 2 to 3 ounces (60 to 90 milliliters) of formula per feeding (for a total of 16 to 24 ounces or 480 to 720 milliliters per day).
- The baby should be up to at least 4 ounces (120 milliliters) per feeding by the end of the first month.
- As with breastfeeding, the number of feedings will decrease as the baby gets older, but the amount of formula will increase to approximately 6 to 8 ounces (180 to 240 milliliters) per feeding.
- On average, the baby should consume about 2½ ounces (75 milliliters) of formula for every pound (453 grams) of body weight.
- At 4 to 6 months of age, an infant should be consuming 20 to 40 ounces (600 to 1200 milliliters) of formula and is often ready to start the transition to solid foods.
Infant formula can be used until a child is 1 year old. The AAP does not recommend regular cow's milk for children under 1 year old. After 1 year, the child should only get whole milk, not skim or reduced-fat milk.
Standard formulas contain 20 Kcal/ounce or 20 Kcal/30 milliliters and 0.45 grams of protein/ounce or 0.45 grams of protein/30 milliliters. Formulas based on cow's milk are appropriate for most full-term and preterm infants.
Infants who drink enough formula and are gaining weight usually do not need extra vitamins or minerals. Your provider may prescribe extra fluoride if the formula is being made with water that has not been fluoridated.
References
American Academy of Pediatrics website. Amount and schedule of baby formula feedings.
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.
Version Info
Last reviewed on: 4/25/2023
Reviewed 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.
