Infant formulas

Definition

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.

Alternative Names

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

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.

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.

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 formula feedings. www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/Amount-and-Schedule-of-Formula-Feedings.aspx. Updated July 24, 2018. Accessed July 6, 2021.

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, eds. Conn's Current Therapy 2021. Philadelphia, PA: Elsevier 2021:1276-1283.