The Formula Conundrum

The Right Stuff

Medically Reviewed by Gary D. Vogin, MD
6 min read

Jan. 28, 2002 -- There's no real formula for choosing a baby formula, and this poses a puzzle for parents. Soy, hypoallergenic, low-iron -- moms and dads can get dizzy staring at the formula choices on grocery shelves. But experts advise keeping it simple: Most infants will do just fine on the standard variety, which is made from cow's milk protein supplemented with iron.

"Optimally, every child should be breast-fed, but given that breast-feeding doesn't work for everybody, I think a standard formula is the place to start," says Melvin Heyman, MD, professor of pediatrics and chief of the division of pediatric gastroenterology, hepatology, and nutrition at University of California, San Francisco.

Most babies tolerate regular baby formula well, says Heyman. Only about 2% of infants develop a food allergy, and cases of colic and other symptoms that can be cured by switching formulas are much less common than parents -- and even some pediatricians -- believe.

"Many people change formulas for no good reason," agrees William Cochran, MD, associate professor of pediatrics in the department of pediatric gastroenterology and nutrition at Jefferson College of Medicine's Geisinger Clinic in Danville, Pa.

If you're considering a switch, check with your child's doctor first. "He or she can give you advice about the risks and what else you may need to do," Dr. Cochran says. For example, introducing new foods early to a baby with a confirmed food allergy could increase the probability the child will develop another allergy.

Many parents lean toward soy formulas because they've heard that babies tolerate soy better than they do cow's milk concoctions. But the fact is, at least half of all infants who have milk allergies are also sensitive to soy protein and should be consuming hypoallergenic formulas.

"Some babies who do OK on soy wouldn't do well on cow's milk formulas," says Heyman, "but the problem is, there's a lot of overlap in reactions, so if somebody has a severe reaction to cow's milk formula, I don't recommend soy."

Another common misconception is that iron-fortified formulas cause constipation or other stomach problems. "Parents will come in and say, 'My kid has gas, he has colic, he's constipated, he has belly pain, and it's due to the iron,'" says Cochran, and the physician will often react to this complaint by switching to a low-iron formula.

In reality, says Cochran, studies indicate that the iron in formula typically is not associated with stomach problems. Moreover, he says, giving babies formula with low-iron concentrations (under 6.7 mg of iron per liter of formula) can increase their risk of iron-deficiency anemia.

The American Academy of Pediatrics recommends iron-fortified formula with 4-12 mg of iron per liter for all bottle-fed infants from birth to 1 year of age. That's because infants don't have enough natural reserves to meet their iron needs. Many baby foods, especially fortified cereals, provide additional iron.

Hypoallergenic formula is easier for babies to digest because the cow's milk protein in it has been predigested, or broken into smaller pieces. One of the most compelling reasons to feed your baby hypoallergenic formula (other than to confirm a cow's milk allergy) is a strong family history of food or environmental allergies, including hay fever and eczema, says Heyman.

A child's risk of a food allergy in the first year increases to about 10% if one parent has allergies and about 20% if both parents do. Hypoallergenic formula is two to three times more costly than regular formula, however, so Cochran advises against it unless both parents have allergies. The "big three" hypoallergenic formulas are Nutramigen, Pregestimil, and Alimentum.

Unlike hypoallergenic brands, Carnation Good Start is only partially broken down (hydrolyzed). It isn't an option if a baby has a known allergy, according to Cochran, but partially hydrolyzed formulas may be worthwhile for babies at somewhat higher risk, such as those with one allergic parent.

"Studies show that in kids who are at risk, if you put them on Carnation Good Start, you can decrease the risk of their developing food allergies," Cochran says. If the infant has a confirmed food allergy, stick with a hypoallergenic brand.

The most common sign that your baby has an allergy to cow's milk protein is blood in the stool, which is caused by milk protein-induced colitis. Switching to a hypoallergenic formula should clear up most of the bleeding in five to seven days. Eczema and respiratory problems also may be signs of milk protein intolerance.

Suzette Bilotti, a first-time mother from Kenosha, Wis., switched her son, Nico, to a soy formula at 9 weeks to help quell problems with gas and spitting up (called gastroesophageal reflux). "A couple of my girlfriends who fed all their kids soy said it made a world of difference, and they told me that may be the reason he's so fussy," says Bilotti.

The truth is, there's little evidence to support that theory. "The data show that very few of these babies actually have true intolerance to proteins, though some do," says Cochran. In addition, only about 1-3% of all infant reflux problems are related to food allergies.

A better, nonmedical reason to use soy formula is because you want to raise your child vegetarian. For a full-term infant, soy protein-based formula, which contains no animal products, is a perfectly acceptable alternative. "Soy formula is nutritionally complete," says Cochran, "so I have no reservations about using it."

Since soy doesn't contain lactose -- the sugar found in milk -- it's also a good choice for infants with lactose intolerance, although this condition is rare among babies. The AAP also recommends soy protein-based formulas when a baby has:

  • Problems metabolizing galactose (one of two sugars that make up lactose)
  • A temporary deficiency of lactase, an intestinal enzyme that breaks down lactose, following an intestinal infection.

Doctors recommend against using soy for infants recovering from diarrhea.

infant nutrition firm Mead Johnson announced a new baby formula is about to hit the market. The product features special ingredients: natural components found in breast milk that the company says have been FDA-recognized for use in baby formula. Mead Johnson is a WebMD sponsor.

The ingredients -- called DHA and ARA -- are fatty acids that are important to a baby's developing eyes and brain. Mead Johnson says its product is the first in the U.S. to include them.

Doctors say a mother's breast milk is still the best nutrition for your baby. This product is not meant to replace breast milk, but to come closer to the real thing for women who cannot breastfeed or prefer to feed their babies from a bottle.

Another brand new option is formula containing DHA (docosahexanoic acid) and ARA (arachidonic acid). These essential fatty acids, important for infant brain and eye development, occur naturally in breast milk. They've been added to European baby formulas for years, and now Mead Johnson's (a WebMD sponsor) FDA-approved version -- Enfamil LIPIL -- will hit store shelves here this month.

In a widely-cited recent study, researchers from Dallas' Retina Foundation of the Southwest, reported that babies fed infant formula enriched with DHA and ARA were cognitively advanced when compared with babies who received commercially available formulas without the fatty acids.

"Pediatricians who are educated about [the fatty acids] have been trying to get it into infant formula for the last decade," says California pediatrician Bill Sears, MD, who has written more than 30 books on infant development and parenting.

"The science is overwhelming that it is beneficial in terms of cognitive development. But even without the science it would be obvious because nature makes very few mistakes. And there is a large amount of [these acids] in breast milk."