The Guide to Infant Formulas: Part 2. The Similac choices

The Pediatric Insider

© 2013 Roy Benaroch, MD

Last time, in Part 1, we talked about the ingredients in infant formulas. Despite the advertising, they’re all much more similar to each other than you’d think. This time I’ll go through the products from the major companies. Infant formulas have complicated and overlapping names—what’s really the differences, and how should you choose?

First, Abbots’ Similac family of products. Get it, “Similac”? Lac, referring to milk; simil, like similar? I like the name! So what have they got in their stable?

Their flagship product for “routine feeding” is “Similac Advance,” a cow’s milk based product that has as much good stuff as any other formula. It’s got the DHA. It’s got the lutein. It’s got a nice baby-blue package. They also market for “routine feeding” Similac Advance Organic, in a green package (green = natural and organic!), which has the same stuff, though a “unique Lutein and DHA blend.” Does unique mean better? Who knows. What it does have as a carbohydrate source is organic cane sugar, which probably makes Similac Organic taste sweeter than human milk or other formulas. I’m not sure that’s a good thing, to get baby used to sweeter tastes, but it might not matter one way or the other. Still, if you’re choosing Similac Organic, you’re choosing the sweet stuff.

On a separate page, Abbott has a number of formulas “for sensitive tummies.” I guess Sim Advance is for those tougher babies! The “for sensitive tummies” choices include Similac Sensitive, which is essentially the same as Similac Advance, but without lactose. Now, lactose intolerance is just about unseen—ever—in human babies, so there is really isn’t any biologic basis for this product to be any better for any babies than Similac Advance. It does come in a soothing orange package. There’s also “Similac Total Comfort”, which has milk-based proteins that are broken down to some degree, “for easier digestion.” In a way, this is their version of Carnation’s “Good Start”—more about that later. There’s no good independent evidence that breaking down these proteins aids in digestion, and it certainly won’t help treat protein allergy. The package is a lightish purple, and reassuringly says it’s FOR DISCOMFORT, then in smaller type “due to persistent feeding issues.” If discomfort is from other things, I suppose the purple packaging won’t help much.

Similac has two more “sensitive tummy” formulas. One is “Similac Soy Isomil” (or what used to be just “Isomil”) which uses soy rather than milk protein. The AAP recommends soy formulas for very few babies—including those from families who wish to avoid cow products, and for the very rare babies with hereditary inabilities to digest certain sugars. For almost all babies, soy is not necessary, and it’s certainly not more digestible than cow’s milk base formulas. The last “sensitive tummy” formula is “Similac for Spit Up” which adds rice starch to thicken the formula, especially once it’s in the low-pH environment of the stomach. They claim it reduces “frequent spit up” by 54%, a nice science-sounding number, based on “data on file”. That means they did the study and haven’t published the result.

There’s also a “Similac for supplementation” formula, designed they say “for breastfeeding moms who choose to introduce formula.” My read of the ingredients shows it’s almost entirely identical to ordinary Similac. It comes in a green container, though a slightly different shade of green than Similac Organic. They claim that by tinkering with the prebiotics, this product may lead to softer stools, though there’s no clinical evidence to support that. I can’t imagine why there needs to be a different formula for supplementing breastfeeding than for routine feeding, but then again I’m not in marketing.

Similac also has an “expert care” area, including Alimentum (genuinely hydrolyzed proteins for the relatively rare babies with real protein allergies), Neosure (for preemies), and Similac Expert Care for diarrhea. I won’t spend much time on these, but they really are for use only when recommended by a physician for specific medical reasons.

Whew. A lot of formulas to choose from! So many colors!

Next: The Enfamil line. Can’t wait!

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16 Comments on “The Guide to Infant Formulas: Part 2. The Similac choices”

  1. Rachel Says:

    Thanks so much for this! My kids are thankfully well beyond the formula stage but there is such a dearth of accurate information about formula feeding out there that I’m sure this will be helpful for lot of moms.

    Like

  2. Alana Says:

    Also chiming in to say how helpful these posts are! I have 25-weeker preemie twins (now 5 months corrected), and I feel like we’ve tried it all (without ever really knowing why!). It’s nice to get some actual information about what’s actually in these products.

    I do have a question though about the protein allergy. We’ve had our son on Nutramigen/Alimentum since he reached full term, due to a “suspected protein allergy”. Recently, it started to seem like he wasn’t tolerating the hydrolyzed formula anymore. We were told to switch to one of the ‘partially broken down, sensitive tummy’ formulas, but based on what you’ve said here, it sounds like he probably never had a protein allergy and could probably just handle the same Similac Advance that his sister’s always been on (much cheaper too, ahem). Do milk protein allergies tend to be over diagnosed??? And probably no real benefit for the ‘sensitive tummy’ formulas then??

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  3. Dr. Roy Says:

    Alana, milk protein allergies are both overdiagnosed and underdiagnosed.

    In some cases, babies with protein sensitivity when young outgrow it– maybe because of changes in the permeability of their gut cells. Depending on the reaction, it is often a good idea to re-challenge. However, how and when to do that depends on clinical circumstances, and parents ought to discuss this with their own pediatricians to get appropriate advice.

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  4. CLL Says:

    Thank you so much for these posts, very, very helpful!

    Like

  5. Al Says:

    My 10 month old baby appears to have a milk protein allergy (he gets a nasty rash on skin contact from milk-based formulas and whole milk), but is able to tolerate Similac Total Comfort.

    Based on this information, I’m finding it confusing as to how he manages to tolerate Total Comfort, if the protein is not broken down in such a way that allergies are affected. Could you help me to understand this more clearly?

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  6. Dr. Roy Says:

    Reactions when a potential allergen touch the skin – called a “contact reaction” – are mediated though a different immunologic mechanism from reactions that start in the gut, from ingestion, and then lead to hives or other skin findings. True contact reactions only occur where the allergen touched the skin directly. Other reactions will be more widespread.

    The good news about contact reactions: they can be annoying, but they do not progress to life-threatening or more-serious systemic reactions.

    It is possible to be allergic via a contact mechanism but not via a systemic mechanism via the gut.

    I suggest you do a “patch test” to see. Pick an area of skin on the arm or leg, and rub on stripes of milk, a different milk-based formula, and Sim Total comfort. Outline the areas with a Sharpie marker, and don’t let them overlap. Then take a photo of the result to post here!

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  7. Al Says:

    Thanks for the input. We will give that a try and post a photo. In terms of contact reactions, does that also refer to a rash around baby’s mouth after he’s eaten something, or would that be systemic?

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  8. Dr. Roy Says:

    Al, a rash around the mouth in a baby is usually a contact reaction, because babies don’t eat very neatly!

    Contact reaction = rash only where food touched the skin directly

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  9. Al Says:

    Hi
    I have a photo of the skin rashes, as requested, but not sure how to post them on the site. You can see a reaction to the milk and milk-based formula, but the Similac Total Comfort is clear.

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  10. Dr. Roy Says:

    Al, you’ll have to host the images at a place like imageshack.us, or facebook, or wherever you’d like, and post a link here.

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  11. aisha Says:

    DR. Roy, you are the best! You truly help us all. Many thanks.

    Like

  12. Joseph Oh Says:

    Hi Dr. Benaroch; I’m a pediatrician here in Oregon. I agree with you that there is no reason that Similac sensitive would be better for almost all infants than standard SImilac. In my practice, however, I’ve had many parents switch to it and swear that their child is doing better on it (less fussy, less bloating, less reflux, etc.). Any idea why this would be? Coincidence? Placebo effect? Or is there a subtle difference between the two formulas that has nothing to do with lactose?

    Liked by 1 person

  13. Dr. Roy Says:

    Counldn’t say, Dr. Oh. We both know that many fussy babies improve with a little time and reassurance… eventually, whatever formula they’re on is labeled the one that “worked.” Certainly, if family says baby doing better on formula X, I’d say “great!” and move on.

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  14. Maryjane Says:

    What about: similac, partiallly broken down protien
    Red, or pink container….
    How is it to regular simulac advance?

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  15. Libby Says:

    We use similac as well. Had some samples of advance and sensitive. We also received some ready made samples of the supplementation. My 5 week old son seemed to do well on all. However, now we’ve run out of the samples and bought more of the supplemental ready made and powder, bc at the time of purchase I was still breastfeeding. I’ve stop using BM at the moment bc he was spitting it all up every time, but now…since yesterday afternoon (after starting zantac from our doctor) he spit up every time except once. I know the zantac is supposed to help that but I’m scared it’s not…or is it me? Am I too nervous or something? I don’t know feel nervous when I feed him, but the only time he didn’t spit up from afternoon through night is the one time my husband fed. So I don’t know what to do. Please help!

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  16. Dr. Roy Says:

    Libby, please call your baby’s doctor for advice. I don’t think the spitting is because you’re nervous. You need your baby’s doctor to help, not advice from the internet. Best of luck!

    Like


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