A: This piece is about the different kinds of baby formulas available in the market. Please remember that, breast milk is the best for your baby and that this information is not a substitute for advice from your child’s health care provider. Also, I have steered away from commercial names but rather mentioned the types of formulae.
There are several baby formulas in the market but each one of them has to conform to very stringent guidelines laid down by the government and FDA. These guidelines are followed very closely by the manufacturers.
They are also under strict surveillance. This means that most formulas in the market within the various groups as I will describe below are quite similar to each other. The differences in brands may be personal preferences plus what the hospital or for example WIC contracts out to essentially for ease of practice, but they all would carry groups of formula from different segments.
The different groups of formulas are based on the source of protein, carbohydrate and their caloric content.
The most commonly used (80-90%) and most abundant of the formulas are cow milk based. They are the ones that would be good for use for most of the term babies and infants. These milk formulas are the closest to breast milk but not a substitute for them. They all have iron added, more lactose added and vegetable oil to try and humanize the milk. Some parents feel that within this group, one is better than the other for their baby, but scientifically there is limited evidence of the same.
So, for example, a lot of babies have reflux in the first few months of life and switching formulas within this group often does not help. Yes, there are some formulas developed for excess reflux and that could be tried; it might help reflux but not necessarily growth and development. In addition, within this group, there are formulas that are more designed for the premature babies.
The second group is soy-based formulas. This does not contain any cow milk product or lactose. They are also referred to as lactose-free formulas. These formulas are quite popular but are designed for babies with rare conditions like galactosemia or lactase enzyme deficiency.
There is limited data, that it will help in colic or quicker resolution from diarrhea. Rarely this type of formula has been used for isolated milk protein allergy. This is a vegan product and that could be one other reason to use it.
The third group of formulas have been used for specific medical conditions, most notably cow milk protein allergy or atopic disease. These are referred to as extensively hydrolyzed protein formulas. They are all lactose free. The protein source is often casein, milk protein, but that has been broken down into much smaller protein pieces and is no longer recognized by the body as the original milk protein.
As expected, these formulas are more expensive and less often needed than the first group. Some of these formulas have higher content of a different kind of a fat, MCT and is used when fat malabsorption is also expected.
The fourth group of formulas is amino acid based formula. These type of formulas is used even less often than the extensively hydrolyzed formulas mentioned above and are used when the baby does not tolerate the latter. These formulae are also lactose free. Besides severe milk allergy, these formulas have been used for other rare gastrointestinal conditions including short gut syndrome.
The above two groups of formulas are also commonly referred to as predigested formulas. Specific medical conditions dictate the use of these specialized formulas.
Finally, there are a variety of formulas for infants who have specific metabolic disorders. In these formulas the protein that is not being metabolized appropriately is removed or its concentration reduced and compensated for by another amino acid to provide for good growth and development. Another type of formula has high fat content e.g. medium chain triglycerides for specific medical conditions.
The children on these specialized formulas need close monitoring by experts in that field.
Finally, I want to say, that it is best to follow the instructions of your doctor and equally important that you pay special attention on how to prepare the formula for your baby safely. Breast milk remains the gold standard, unless it is specifically contraindicated, which is an extremely rare event.
Pankaj Vohra is a Pediatric Gastroenterologist at UNM. Please send your questions to email@example.com.