Since 2022, there have been many new choices in the baby formula aisle. While breastmilk is always preferred (unless mothers have certain medical conditions or are taking certain medications), there are some babies who will need formula. So here are some tips to know when trying to decide on a formula. Always remember to run your choices by your baby's pediatrician to make sure it is suitable for your baby.
When talking about baby formulas, I find it helpful to divide them up into 4 categories:
US manufactured, traditional US formulas
European/Imported formulas
US manufactured, "European style" formulas
Foreign formulas not approved for sale in the US
Traditional US formulas- These products such as Enfamil, Gerber, and Similac are nutritionally complete for your baby. There are many different types of baby formula on the market based on the type of protein (cow milk, plant based/soy) and how broken down the protein is.
European/Imported formulas- Products such as Kendamil, Aptamil, Kabrita, and Bubs have been given the green light by the FDA to market their products in the US. Again there are many varieties based on the type of protein (cow milk protein, goat milk protein). Kendamil and Bubs have both cow and goat milk based products. Kabrita only sells goat milk based baby formula. In general, European formulas have lower amounts of iron than is recommended by the American Academy of Pediatrics (AAP). Due to the low iron levels in these formulas, it is recommended that babies taking these formulas receive additional iron supplementation. European formulas also have higher amounts of DHA (docosahexaenoic acid), an omega-3 fatty acid than traditional US formulas. DHA has been linked to improved neurodevelopment.
US manufactured, "European-style" formulas- These products include formulas such as Bobbie, By Heart, Baby's Only and Happy Baby Organic. Although these formulas are manufactured in the United States, their nutritional profile is similar to the "European/Imported" formulas. Therefore some have less iron and more DHA than traditional US formulas. If you are using one of these products, check with your pediatrician to see if your baby requires more iron to meet the AAP recommendation of 1.5-1.8 mg iron/100kcal. These formulas, like their European equivalents, often come in different "stages". It is important to choose the correct stage for the age of your baby. (i.e. Stage 1, birth to 6 months; Stage 2, 6 mo-12 mo)
Foreign formulas not approved for sale in the US- Examples of these baby formulas include Hipp and Holle. These products are not approved for distribution in the United States. They arrive in the US through 3rd party vendors and there are no safeguards in place to ensure the safety and quality of the product. The labels with mixing instructions are in the language of the originating country, making it difficult for some to understand how to mix the formula. If there is a recall on these products, the information is not as readily available to US consumers as it is for FDA regulated baby formulas.
The American Academy of Pediatrics has recently stated that both cow milk protein and goat milk protein based infant formulas are safe for babies. Many parents find goat milk formula to be more gentle and easier to digest, but the studies to show this are lacking. European/Imported and "European-style" baby formulas are not a good choice for premature babies. Premature infants should never be placed on a low iron formula. Premature babies miss out on the last trimester of pregnancy, a time when iron is transferred to the baby from the mother. If you have a preterm baby and you are feeding formula, the recommendation is to use either Enfacare or Neosure. These formulas have additional calories and minerals (including iron) to maximize your baby's nutrition. Your pediatrician can guide you on exactly how long to continue that formula after hospital discharge. The current recommendation is a minimum of 3 months post NICU discharge.
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