A Blog from Your Kaiser Permanente Pediatricians in Northern California

Father giving baby a bottle

Understanding Formula Choices

When other moms in a mother’s support group recently told my friend her use of formula to supplement her breast milk was like “feeding him fast food when you should be feeding organic,” I was shocked. Maybe I shouldn’t have been – because parents receive unsolicited advice and criticism from all sides.

To judge my friend, who had the best intentions for supplementing her breast milk with formula, was wrong. Mother’s support groups are often an invaluable source of help and information – she should have felt accepted and supported by this group! There are many ways to raise a child well, and while breastfeeding is the healthiest choice for babies, it’s sometimes difficult to do.

Let’s look at the options for formula if you choose to use it to supplement breast milk or alone.

Your physician and lactation consultant will offer you all the help you need to breastfeed successfully. But it doesn’t always work. It may not work for many reasons, or it may not be the right choice for your family. No one should be judged.

If offering formula, there are many good choices – not all make sense, so let’s run through them. A good and funny new book, Looking Out for Number Two, written by a fellow pediatrician and friend, Dr. Bryan Vartabedian, does a great job of outlining the choices:

  • Basic cow milk formulas. These are made by a handful of manufacturers and are very similar. There’s no medical reason to switch between these basic brands (also no harm if you believe one works better). Buying big-box store or pharmacy brand formulas to save money is fine (they’re all regulated by the FDA, so they’re similar and safe). Formula with added probiotics is a good choice – these bring formula closer to breast milk.
  • Hypoallergenic formulas. A small number of babies (3 to 5 %) are allergic to cow’s milk formula and need to use this option. It tastes lousy and costs loads, so skip it unless you and your doctor have diagnosed a true allergy; it doesn’t benefit a baby who’s not allergic to cow’s milk.
  • Lactose-free formulas. Babies aren’t lactose intolerant; there’s no reason to buy these formulas. Breast milk has lactose. When babies are allergic to cow’s milk, the allergy is to the milk proteins, not the sugar (lactose), so feeding an allergic baby lactose-free formula will not help. The only time these might make sense is after a baby has had a bad stomach virus. Ask your pediatrician.
  • Soy formulas. These only make sense if your baby is allergic to cow’s milk formulas and then only sometimes. About half of cow’s milk allergic babies are also allergic to soy.
  • Follow-up formulas. These are the ones marketed for babies after their first birthday. Unless your pediatrician feels your child is not growing well or has a diet so limited that nutrition is lacking, there’s no reason to use these formulas. Young children seem picky and seem like they aren’t eating much, but they’re usually eating enough to thrive.

A couple of other points to remember:

  • Babies who are sensitive to cow’s milk protein will respond to cow’s milk formula but also to breast milk when mom has been eating cow’s milk products. They can have several symptoms including blood or mucus in their poop, as well as diarrhea, vomiting, or fussy behavior and lots of crying. Talk with your pediatrician when you see these signs.
  • Don’t give a baby regular cow’s milk as a main source of nutrition until they’re over 12 months. It doesn’t provide the proper nutrients to help a human baby grow! However, offering dairy products like yogurt and cheese when your baby starts solid foods is fine.

Breast milk is the healthiest choice for your baby – no doubt. However, if you need to supplement with formula, no one should judge your choice.

For support, see our page on breastfeeding your baby.

Find more resources for parents:
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