Further Reading

What type of formula should I choose for my newborn?

by Amy R. Beach, FNP-BC, CLC

This is a frequent question when a newborn is seen, and with the many options now available, the choice has become more complicated. The American Academy of Pediatrics (AAP) continues to recommend exclusive breastfeeding through 6 months of age. However, if formula is chosen, here are some guidelines to help the decision process.

Formulas can be divided into 4 different categories; cow’s milk-based formula, hydrolyzed cow’s milk formula, soy formula, and amino acid-based formula.

Cow’s milk-based formula is the most commonly used. This type of formula is recommended by the AAP for “all infants who are not breastfed, or who are only partially breastfed, from birth to 1 year of age.” These formulas can be marketed with added ingredients. DHA and ARA are fatty acids that are thought to promote brain and eye growth. Probiotics are considered “healthy bacteria” which can aid in digestion, and prebiotics, such as “HMO,” may be of benefit in preventing eczema. Formula marketed to help with “reflux” has added rice. While some of these additives may be helpful, it is best to discuss these alternatives with your pediatrician prior to use.

Hydrolyzed formula is still a cow’s milk-based formula, but the milk protein has been broken down into much smaller proteins making it easier to digest and less allergenic. There are partially hydrolyzed formulas or extensively hydrolyzed. Hydrolyzed formulas are typically more expensive. They can be indicated for infants who have a family history of eczema or atopic dermatitis or for milk protein intolerance/allergy.

Soy formulas are not typically recommended unless there is a specific indication from the pediatrician. In the past, this type of formula was used if an infant seemed to not tolerate a cow’s milk-based formula or had an allergy to it. However, frequently infants who are truly allergic to the cow’s milk protein will often be sensitive to the soy protein as well.

Occasionally, an amino-acid based formula will be prescribed. This type of formula uses basic amino acids as the building blocks for protein rather than whole proteins. They are very costly and should only be used when prescribed by the pediatrician.

Once a formula is chosen, it should be used for a week or more to see how the infant tolerates it, unless the pediatrician recommends a change. Too frequent changes can upset the digestive system and result in increased fussiness and stool changes. Breastfeeding is best, but if formula is chosen, navigating the many types can be confusing. As always, discuss the topic first with your pediatrician for their recommendations and insight.