Choosing The Best Formula For Your Baby
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I went to the grocery store alone…
And I stood there reading labels and researching the ingredients on my phone. Every canister I picked up had at least 30 ingredients listed on the label. I’ve been told not to eat food myself that has more than 10 ingredients because it indicates an overly processed food. If that’s true for me, did I need to be worried about it with baby formula too? Or could I trust that formula manufacturers had developed something nutritious and healthy for my baby? I needed to make a quick decision. Daddy was at home with a fussy, hungry baby because my milk production had been next to zilch that day.
Like many first-time moms, I naturally assumed breastfeeding would work for us, so I didn’t look into alternatives to breastfeeding. There I was in those first few weeks disappointed, overwhelmed, and confused because I had heard nothing but “breast is best,” the gold standard, the way to feed my baby, but I couldn’t breastfeed - and now I needed to find a good formula for my newborn son. I wanted to give him the next best thing. But as I stood there reading labels, I couldn’t decide what that should be.
Finding whole, nutritious foods is tedious anyway, especially in a marketplace where you have to look for non-GMO, antibiotic-free, no growth hormones, and figure out exactly what natural flavor really means.
We used an organic cow milk formula for a while, but my buddy had moderate to severe GER (acid reflux) and issues with digestion and constipation on this kind of formula. When we switched him to goat milk formula (which I share more about in this post), we saw major improvements in his overall well-being and kept him on the same formula until he was weaned at one year!
Whether you’re about to use formula for the first time or you know in your gut that your baby’s current formula isn’t working, you don’t have to play formula roulette! Advice will come in many forms, so don’t let someone - even a professional - scare or shame you into a decision. I’ve laid out a lot of information here, but your baby’s health is dependent on so many other factors than infant formula. The goal is to simply guide you to the best formula for your baby.
Below is an overview of the pros and cons of each baby formula type to simplify the process. Please comment with questions if you need further guidance!
How do I choose the most healthy option?
If you’re trying to find the absolute most healthy, best formula opt for a formula that specifies 4 things it does not do;
1) Use artificial sweeteners as the main carbohydrate source (lactose is the most natural sugar). Remember that ingredients on a label are in order of greatest amount to least amount. Therefore, if sugar is the first ingredient, that means the product contains more sugar than any other ingredient. Look for a formula with lactose rather than sugar. See formula options below if your baby needs a lactose-free formula!
2) Contain GMO (genetically modified) ingredients, whether intentionally or through production. This won’t always be spelled out in the ingredients. Some products will also claim “non-GMO,” but if you read the fine print on the label, the same product will also say, “Trace amounts of genetically modified material may be found in product through manufacturing…” Look for this disclaimer.
3) Use hexane (a chemical agent used to extract protein, oils, or DHA from its original source to be used in formula). This one is harder to tell because you’d have to research the company or formula to see how they get their ingredients. However, if a company does not use hexane, they will probably claim it, usually on their label.
4) Use milk from cows treated with rBST or rBGH (growth hormones). Studies are still showing that, “No significant difference has been shown between milk derived from rbST treated and non-rbST treated cows.” However, significant difference means that, statistically, there’s less than a 5% chance that cows treated with hormones are different than cows not treated with hormones. Frankly, more research needs to be done, but play it safe if you can.
Honestly, it can be difficult to find a formula that falls in line with all 4 points. Most organic brands cover at least 3 of the 4. See below for mom-approved organic brands. If your baby needs an alternative to cow milk formula, keep scrolling for formula alternatives for babies with allergies, intolerances, or sensitivities.
Regular ole’ Cow Milk Formula
Enfamil Infant, Similac Pro Advance, Gerber Infant
Organic brands - Similac Pure Bliss, Happy Baby Organic, Earth’s Best Organic, Baby’s Only Organic, The Honest Co. Organic, Plum Organic
Cow milk formulas have been around the longest and are the most affordable option on the market. The main ingredients are powdered cow milk (protein), lactose (carbohydrate), and oils (fat), with the addition of vitamins, minerals, and sometimes special nutrients like DHA (an omega-3 fatty acid which aids in healthy brain, heart, and muscle development) and ARA (growth of muscle tissue and helps manage inflammation in the body). These nutrients are recent additions as more has been learned about the composition of breast milk, although studies are still mixed on whether they make a developmental difference. Nonetheless, most formulas on the market today contain added DHA/ARA and we hope we’re paying the extra cost for nutritional benefits.
Pros
Most affordable option
Carbohydrate source is usually lactose, which is healthier than glucose syrup, corn syrup, or sugar
Least processed since the protein is not hydrolyzed (as in hypoallergenic formulas, mentioned below), but organic is the more healthy option as the milk typically comes from cows not treated with rSBT or other hormones and antibiotics (check the label).
Cons
Not a good option if baby has a cow milk protein allergy (CMPA) or a lactose intolerance
Even if baby does not have a dairy allergy, she may become sensitive to cow milk proteins
Hardest to digest because the proteins are in their (large) original form (This is where “sensitive” formulas or alternatives to cow formulas come in.)
“Sensitive” Cow Milk Formula
Similac Pro-Sensitive, Happy Baby Organic Sensitive, Gerber Good Start, Enfamil Enspire
These formulas typically contain partially hydrolyzed proteins and/or whey protein concentrate, as well as an alternative carbohydrate source to lactose, such as corn syrup, glucose syrup, brown rice syrup, corn maltodextrin or another sugar alternative. These ingredients are intended to ease digestion since regular cow milk proteins (ones that have not been hydrolyzed) and lactose are harder on your baby’s digestive system.
There are 2 types of protein in milk - whey and casein - and whey is easier to digest than casein. The whey to casein ratio in breast milk is 60:40, while the ratio in cow milk is 20:80.
This option may be best for the baby with a digestive sensitivity, not necessarily a milk allergy. Only a very small percentage of babies are truly lactose intolerant, but many sensitive formulas are still lactose-free. The list of ingredients on the label will show if the formula utilizes lactose or an alternative sugar for carbs. Lactose is the most natural carbohydrate source, so when choosing a sensitive formula, look for one with lactose rather than artificial sugar substitutes - unless your baby is lactose intolerant due to galactosemia or another disorder.
Pros
Costs more than ‘regular’ cow milk formula but still not as expensive as hypoallergenic formula
Good option for babies who have digestive discomfort with regular cow milk formula but don’t need the more expensive hypoallergenic or elemental formulas
Whey protein is easier to digest - check the label to see if your sensitive formula uses more whey (it’s usually listed as “whey protein concentrate”)
Cons
Some nutritionists caution that milk protein isolate still contains 1-2% lactose, so if baby is ultra sensitive, go with a lactose-free option that does not contain an “isolate” form of milk. (It will say “isolate” or “concentrate” in the list of ingredients if using whey protein.)
Many sensitive formulas also replace the lactose with another sugar, which may not be necessary for your baby - lactose is the healthiest carbohydrate source (closest to mom’s breast milk)
Hypoallergenic Formula (Hydrolyzed or Partially Hydrolyzed Protein)
Enfamil Nutramigen, Similac Alimentum, Enfamil Pregestimil, Gerber Extensive HA
These are specially designed for babies with a confirmed cow milk protein allergy (CMPA) and/or lactose intolerance. Extensively hydrolyzed means that the proteins are broken down in advance so that baby’s body does not recognize them as allergens and initiate an immune response. If your baby only has a sensitivity to cow milk (as was the case with my son), a hypoallergenic formula may not be necessary. Read the label carefully to determine which formula may work best for your baby’s particular needs. For example, Similac Alimentum and Enfamil Nutramigen use hydrolyzed proteins and free amino acids, and they also replace the lactose with corn syrup (or another sugar), making them hypoallergenic. Some hypoallergenic formulas, however, contain only partially hydrolyzed proteins and/or more whey protein to ease digestion - and this difference could be important for your baby. Likewise, some formulas like Pregestimil are developed specifically for babies who have trouble digesting fats.
Pros
Great option for babies who have several allergies or digestive issues when other formulas have not worked
Recommended for babies with unmanageable acid reflux (GER or GERD)
Can sometimes be covered by insurance companies or purchased wholesale
Cons
The cost is high and these are generally better in ready-to-feed forms - which are the most expensive option
Bad taste, so baby will need to time to adjust
Typically uses an alternative sugar to lactose/artificial sweetener - look for a formula where sugar is not the very first ingredient
Elemental Formula
Enfamil PurAmino, Nutricia Neocate, Abbott Elecare
The most simple way I have heard these described is extra hypoallergenic formulas. In these formulas, there aren’t even proteins to digest because they are made of free amino acids (the building blocks of proteins). Baby’s body does not need to work hard to digest nor does it recognize anything as an allergen since there are no real proteins. If your baby has not responded well to hypoallergenic formula and/or still experiences fussing, crying in pain, blood in stools, or poor weight gain, this may be a good last resort. Your pediatrician or holistic health care provider will be able to check your baby’s stools and look for other signs that an elemental formula may be an appropriate alternative. Elemental formula is expensive compared to other types of formula, but you can check with your insurance about covering the expense.
Pros
Usually a good ‘last resort’ if baby does not tolerate mom’s milk or other formulas
Good option for babies with multiple allergies, malabsorption issues, or a digestive disorder
Can sometimes be covered by insurance companies or purchased wholesale
Cons
Most expensive type of formula if your insurance company does not cover costs
Usually special order - you may be hard-pressed to find one of these at your local grocery store and will have to plan ahead to order
Terrible taste - just like with hypoallergenic formulas, the earlier baby can start, the better, so that she has time to adjust
Goat Milk Formula
Kabrita, Holle, HiPP, Mt. Capra, Nanny Care, Sammy’s Milk
Goat milk formula is a relatively new alternative on the market but is quickly growing in popularity. Goat milk protein is easier to digest than cow milk protein (due to size and structure), less allergenic and inflammatory than cow milk, contains more of the essential fatty acids linoleic acid and arachnodonic acid, or ARA (found in mom’s breast milk), and has higher values of calcium and potassium.
The common allergen in cow milk is alpha casein-1, which is less present in goat milk, as goat milk contains more alpha casein-2 (A2 proteins). This kind of formula could work for babies with an allergy to cow milk but would need to be tried for your baby’s individual needs. Some brands, like Kabrita do not recommend use if your baby has a true cow milk protein allergy, but do recommend if your baby has a sensitivity to cow milk formulas. It’s worth reading up on the individual brand if you decide to go with a goat milk formula as some do claim to be good for babies with allergies. In such cases, goat milk formula is a healthier choice than hypoallergenic or elemental formula.
Personally, we liked the goat milk formula from Mt. Capra because of all the options it seemed to truly be the closest to breast milk (bearing in mind that no formula can mimic breast milk too closely). It only has 6 ingredients + 4 ingredients you add once per day (vitamins, probiotics, colostrum, DHA).
Pros:
Good option for babies with cow milk sensitivity or sensitive tummy
Easier to digest because the proteins are smaller - so they do not need to be hydrolyzed
Lactose - rather than artificial sugar - is the carbohydrate source
Cons
Not readily accessible and usually needs to be ordered
May not be a good alternative for babies with cow milk protein allergy, depending on if baby’s immune response is the same to goat milk as to cow milk
Can be as pricey as hypoallergenic, depending on the brand
Homemade Formula
The argument can also be made that homemade formula is the most healthy formula since it’s not processed in a factory. Of course, the risks with homemade formula include the use of raw, unpasteurized milk, which may contain harmful bacteria (as well as good bacteria that is healthy for baby’s gut) and the precision required with preparing formula at home. If this option doesn’t scare you and you’d like something more natural and wholesome than commercial formula, the Weston A. Price foundation has a popular homemade recipe with several handy recipe charts. The goat milk formula we used is also considered a homemade formula, the difference being that the milk is in powder form! So there’s no risk with using unpasteurized milk. There’s a starter kit available to help first-timers with making the formula.
Soy Formula
ProSoBee, Similac Isomil
Some families may want to avoid dairy products altogether, and using soy formula is one way to do that. When it comes to allergies, many infants who are allergic to cow milk protein may also be allergic to soy protein. Because both tend to be much larger than the proteins found in mom’s milk, something hydrolyzed would be better. Soy formula, however, usually contains soy protein isolate, which means that the protein has been isolated through a process of dehulling and defatting the soybean. The jury is still out on the long-term effects of soy protein isolate on estrogen levels. There are also studies dating back to 1996 that indicate soy-based formulas have higher aluminum content than any other formula. Aluminum competes with calcium for absorption in the body - but babies need hearty levels of calcium for bone development. That said, short-term use of soy formula may be recommended in some cases of illness, such as when baby has a temporary lactose intolerance due to a stomach virus or another illness.
Pros
Good option if you’re trying to avoid giving dairy to baby
Plant-based rather than animal-based if you are vegan or have trouble digesting animal proteins
Can be a good and affordable temporary option when baby is recovering from stomach illness
Cons
Scientists are still determining the effect of phytoestrogens on the body with long-term use
More expensive than cow milk formula
Typically uses soy protein isolate, a processed version of soybean
Contains higher aluminum levels, which affect calcium absorption in baby’s body
As always, choose a pediatrician whose medical expertise and advice you trust and work with them to choose the best nutrition for your baby. Advice will come in many forms, so don’t let someone - even a professional - scare or shame you into a decision. Also, be gracious with yourself. I’ve laid out a lot of information here, but your baby’s health is dependent on so many other factors than just formula. In this article, I compare costs for different kinds of formula. If you are interested in goat milk formula, I also wrote about why we chose a goat milk formula for my baby boy. You can also find a more in-depth look at the nutrient make-up of infant formula (if you really want to nerd out with me) in this article!
