How to Choose the Best Formula for Newborns

Choosing an infant formula can feel overwhelming when you are faced with numerous tins, different formulations and a long list of ingredients. There is no single formula that is best for every newborn. The appropriate choice depends on your baby's age, health, nutritional needs and whether there is a specific reason to use a specialised formula.

For most healthy, full-term newborns who need formula, a standard first infant formula is suitable. Babies who are premature or have a diagnosed allergy, metabolic disorder or other medical condition may need a different formulation.

Breast milk is recommended as the sole source of nutrition for the first 6 months when breastfeeding is possible. When breast milk is not available, or formula feeding is needed, infant formula can provide the nutrition required during early infancy.

For a healthy, full-term newborn, choose a standard infant formula intended for use from birth. These formulas are designed to provide the protein, fat, carbohydrate, vitamins and minerals needed for growth and development.

Age is an important consideration. First infant formulas are intended for young babies, while follow-on formulas are designed for older infants. A follow-on formula should not be used for a newborn simply because it contains different or additional ingredients.

The choice becomes more specific when your baby has a medical condition, was born prematurely or is not growing or feeding as expected.

Most newborns can use a standard cow's milk protein-based formula. Other formulations are available for particular nutritional or medical needs.

Cow's milk protein formula

Most standard infant formulas are based on cow's milk proteins that have been modified to make them suitable for infants. They are generally appropriate for healthy, full-term babies who do not have a diagnosed cow's milk protein allergy.

The fact that a formula is based on cow's milk does not mean that it is the same as ordinary cow's milk. Infant formula is specifically formulated to meet the nutritional requirements of babies.

Soy formula

Soy formula contains soy protein instead of cow's milk protein. It has a role in selected circumstances, but it is not routinely recommended as a treatment for cow's milk protein allergy because some babies with cow's milk protein allergy also react to soy.

Lactose intolerance is uncommon in young infants. Symptoms such as gas, crying or changes in stools do not automatically mean that your baby needs a soy or lactose-free formula.

Partially hydrolysed formula

Partially hydrolysed formulas contain proteins that have been broken down into smaller fragments. They are sometimes used for specific feeding needs, but they should not be used to treat confirmed cow's milk protein allergy.

A partially hydrolysed formula is different from an extensively hydrolysed formula, in which the proteins are broken down much more extensively.

Extensively hydrolysed formula

Extensively hydrolysed formulas contain proteins that have been broken down into much smaller fragments. They may be recommended for babies with cow's milk protein allergy.

If an allergy is suspected, a paediatrician should assess the symptoms and determine whether an extensively hydrolysed formula is appropriate.

Amino acid-based formula

Amino acid-based formulas contain individual amino acids rather than intact or hydrolysed milk proteins. They may be recommended for babies with severe cow's milk protein allergy or for those who do not respond adequately to an extensively hydrolysed formula.

These are specialised formulas and should be used with medical guidance.

Other specialised formulas

Formulas are also available for particular nutritional and medical needs, including some products for premature or low-birth-weight babies and formulas used in the management of certain metabolic disorders.

Thickened or anti-reflux formulas may be considered for some babies with troublesome regurgitation. They are not appropriate for every baby who spits up, and persistent or severe vomiting should be assessed by a healthcare professional.

Know More About Baby Food

For most healthy, full-term newborns, you do not need to compare every ingredient in different formulas. A standard first infant formula should provide the nutrients needed for normal growth and development.

Iron is important during infancy, and standard infant formulas are generally fortified with iron. You may also see ingredients such as DHA, ARA or prebiotics on the label. These can form part of a nutritionally complete formula, but the presence of one particular ingredient does not make a formula universally better for every baby.

Some of the nutrients commonly found in infant formula include:

What about DHA and ARA?

DHA and ARA are long-chain fatty acids found naturally in human milk and added to many infant formulas. DHA is an omega-3 fatty acid, while ARA is an omega-6 fatty acid.

Their presence can be considered as part of the overall nutritional composition, but they should not be used on their own to decide which formula is best for your baby.

Does the whey-to-casein ratio matter?

Infant formulas can differ in the type and proportion of milk proteins they contain. There is no single whey-to-casein ratio that makes a formula suitable for every baby, and a particular ratio should not be treated as a measure of quality or guaranteed digestibility.

Your baby's tolerance, growth and overall health are more useful when assessing whether a formula is suitable.

Should you choose a formula without sucrose?

There is no need to choose a formula solely because it is advertised as being free from a particular carbohydrate. Infant formulas can contain different carbohydrate sources while providing the nutrition required for infants.

Rather than focusing on one ingredient, consider whether the formula is appropriate for your baby's age and nutritional needs.

The right formula depends largely on whether your baby was born at term, is growing normally and has any specific medical or nutritional needs.

Healthy, full-term newborn

For a healthy, full-term newborn without a diagnosed medical condition, a standard first infant formula is usually appropriate.

There is no need to change to a specialised formula simply because your baby has occasional gas, cries during some feeds or spits up from time to time.

Premature or low-birth-weight baby

Babies born prematurely or with a low birth weight may have nutritional requirements that differ from those of full-term babies. Some may need additional calories, protein or other nutritional support.

The appropriate feeding plan depends on factors such as gestational age, birth weight, growth and medical condition. Follow the feeding plan provided by your baby's neonatal or paediatric team.

Suspected cow's milk protein allergy

Cow's milk protein allergy can cause symptoms such as vomiting, blood or mucus in the stool, eczema or poor growth. These symptoms are not specific to allergy, however, and can have other causes.

If cow's milk protein allergy is suspected, a paediatrician can assess your baby and recommend an appropriate formula if necessary. A standard or partially hydrolysed formula should not be used to treat a confirmed allergy.

Persistent digestive symptoms

Gas, crying, spit-up and changes in stool frequency are common during early infancy. They do not necessarily mean that your baby is not tolerating the formula.

Persistent vomiting, diarrhoea, blood in the stool, feeding difficulties or poor weight gain should be assessed rather than managed by repeatedly changing formula.

Family history of allergy

A family history of allergy does not automatically mean that your newborn needs a specialised formula. If your baby has symptoms suggesting an allergy, discuss them with your paediatrician rather than choosing a hypoallergenic formula solely because allergies run in the family.

A formula change may be appropriate when there is a clear nutritional or medical reason. It is usually not necessary after a single unsettled feed or occasional spit-up.

Before changing formula, consider whether your baby is feeding comfortably, gaining weight and otherwise well. If symptoms are persistent or concerning, speak to your paediatrician so that the underlying cause can be assessed.

Do not dilute, concentrate or combine formulas differently from the preparation instructions. Adding cereal, medicines, vitamins or other ingredients to a bottle should only be done if your baby's healthcare professional has specifically advised it.

Some medical conditions require a specific feeding plan rather than a standard infant formula.

For example:

• Babies with confirmed cow's milk protein allergy may need an extensively hydrolysed or amino acid-based formula.
• Babies with phenylketonuria need a phenylalanine-restricted feeding plan.
• Babies with galactosaemia require a feeding plan that avoids lactose and galactose.
• Some premature or low-birth-weight babies may need specialised nutritional support.
  These conditions cannot be diagnosed reliably from a single symptom. A paediatrician or specialist dietitian should guide the choice of formula.

If your baby develops breathing difficulty, facial or tongue swelling, marked lethargy or other signs of a severe allergic reaction after feeding, seek urgent medical attention.

Correct preparation is essential. Adding too much or too little water changes the nutritional concentration of the feed.

When preparing powdered formula:

• Wash your hands and clean the preparation surface.
• Use clean feeding equipment.
• Use a safe water source.
• Measure the water first, then add the exact amount of powder specified for that formula.
• Use the scoop supplied with the product.
• Do not add extra powder to make the feed stronger or extra water to dilute it.
• Prepare feeds as close to feeding time as practical.
• Powdered infant formula is not sterile. This is particularly important for very young babies, premature infants and babies with weakened immune systems. In some circumstances, ready-to-feed liquid formula may be recommended because it is sterile until opened.

Preparation recommendations can vary according to the baby's age, health and local guidance. Follow the preparation instructions for the formula you are using rather than applying a single temperature or method to every infant.

Formula does not need to be warmed before feeding. If you choose to warm it, do not use a microwave because it can heat the formula unevenly and create hot spots that may burn your baby's mouth.

Prepared formula should be handled carefully because bacteria can multiply in it.

Use prepared formula within 2 hours of preparation and within 1 hour after feeding begins. If prepared formula will not be used within 2 hours, refrigerate it promptly and use it within 24 hours.

Discard any formula left in the bottle after a feed. Once your baby has started drinking, saliva can introduce bacteria into the formula.

Keep unopened formula in a cool, dry place. Once opened, keep the container tightly closed and follow the storage instructions for that product.

Newborns usually feed frequently, but the amount they take can vary according to their age, weight, growth and individual needs.

Rather than expecting your baby to finish a fixed volume at every feed, pay attention to hunger and fullness cues. Rooting, bringing the hands towards the mouth and becoming more alert can indicate hunger. Turning away, closing the mouth or becoming relaxed may indicate that your baby has had enough.

Your paediatrician can advise on appropriate feeding volumes based on your baby's weight and growth.

If your baby consistently feeds poorly, is difficult to wake for feeds, has significantly fewer wet nappies or is not gaining weight as expected, seek medical advice.

Talk to your baby's paediatrician if you are unsure which formula is appropriate or if your baby is having ongoing feeding problems.

Medical assessment is particularly important if your baby has:

• Persistent or repeated vomiting
• Blood in the stool
• Significant or persistent diarrhoea
• Difficulty feeding or swallowing
• Poor weight gain
• Symptoms that may indicate an allergy
• Signs of dehydration
• Breathing difficulty or facial swelling after a feed
• Unusual sleepiness or difficulty waking for feeds

Newborns can become unwell quickly. A significant change in feeding, alertness or urine output should therefore be assessed promptly.

For most healthy, full-term newborns who need formula, a standard first infant formula is appropriate. The choice becomes more specific when a baby is premature, has poor growth, develops symptoms suggesting an allergy or has another medical or nutritional condition.

Choosing the right formula is only part of safe formula feeding. Correct preparation, hygienic handling, appropriate storage and attention to your baby's feeding cues are equally important. If your baby is not feeding well, is not gaining weight or develops concerning symptoms, speak to a paediatrician.