Classic vs. Modern Formulas

Q: As a grandmother I'm curious why there are so many infant formulas nowadays. Why don't doctors recommend Carnation or Pet evaporated milk formula anymore? Back in the early sixties that's all mothers had. The babies did better with the evaporated formula than with the formulas of today, when newborns seem to change formulas a lot before finding one that agrees with them. And the old formulas were less expensive. Why the change?

The other day I was looking at the feeding instructions my mother was given when I was a newborn sixty-four years ago. She was advised to begin feeding me cereal at just three weeks of age. We know so much more about infant nutrition now, and we understand that an infant's gastrointestinal tract matures much slower than was once thought. My mother would not receive that same recommendation today, because we now understand that a baby's gastrointestinal tract is not mature enough to tolerate solids well until around six months.

The infant formulas of today really are much better than they were in the days when they were composed of evaporated milk and syrup. Today's formulas are nutritionally superior to the homemade ones you mentioned. They contain better amounts of added iron, vitamins, minerals, and essential fats. And since the passage of the Infant Formula Act in 1985, formula safety is tightly regulated by the FDA.

Your concern that parents of today change formulas a lot is a valid one. In my experience, often it's not the formula that causes baby to be upset, it's the method of feeding. Many parents give their babies too much formula in one feeding. For many babies, their intestinal enzymes are not mature enough to quickly digest a whole big bottle of formula. All that undigested formula can cause constipation, diarrhea, or abdominal pain. Before changing formulas, it's better to try decreasing the volume and increasing the frequency of the feedings. Here's Dr. Bill's rule of thumb for feeding babies with intestinal upsets: "Feed baby half as much, twice as often."

But the best advance in infant nutrition lately is that more and more mothers are breastfeeding. In the days of evaporated milk formula, only around twenty percent of mothers breastfed their infants. Nowadays, in some areas of the country (especially the East and West coasts), a large percent of mothers leave the hospital breastfeeding their babies. Even though today's infant formulas are nutritionally superior to those of many decades ago, mother's milk will always remain the nutritional gold standard for babies.

Choosing the Right Formula

If you still suspect your baby needs a change of formula, you want to make sure your choosing the right formula for your child. A good baby formula should be:

Milk-based. Unless advised otherwise by baby's doctor, choose a formula that uses cow's milk as the protein source. In babies who are allergic to cow's milk protein, a soy protein-based formula is an alternative, but most infants tolerate cow's milk-based formulas quite well.

Iron-fortified. To prevent anemia (low-blood hemoglobin), babies need iron-fortified formulas. You will see "low iron" on the label of some formula cans. The American Academy of Pediatrics states that low-iron formulas have no place in infant nutrition. I agree. Some formula manufacturers have reduced the amount of iron in order to address the myth that iron can be upsetting to infant intestines. Controlled studies comparing low iron and regular iron formulas have shown no difference in the incidence of intestinal upsets.

Enriched with DHA and ARA. The addition of these brain-building fats is the newest improvement in infant formulas, so you won't find them in all formulas. Studies over the last ten years have shown that infants fed formulas enriched with these two fats show improved visual and cognitive development. More and more formula companies are routinely adding these fats, so look on the label for "enriched with DHA and ARA."

Hypoallergenic. If your last formula caused your baby to be "colicky," you might want to consider hypoallergenic formula. Some babies are allergic to cow's milk protein, so the cow's milk protein in hypoallergenic formulas has been predigested. These formulas are not for every baby -- they are much more expensive and less palatable than the standard formulas. Ask your baby's doctor about this first. Finally, take note that the Committee on Nutrition of the American Academy of Pediatrics does not recommend the routine use of soy formulas just because baby is "colicky."