The Guide to Infant Formulas: Part 5. The Final Recommendations

The Pediatric Insider

© 2013 Roy Benaroch, MD

Choices for bottle feeding are truly overwhelming. There are at least 20 different formulas out there—and I’m not even counting the special medical formulas for specific medical indications. Which one is the best for your baby?

The best “formula”, of course, is human milk. It’s cheap, it’s nutritionally super-good, and for many women it’s very convenient and easy. But it’s not for everyone. Some families like to supplement, or some families choose to bottle feed; some moms try their best but for whatever reason exclusive breastfeeding doesn’t work out. That is not a disaster, not by any means. We’ve got very good and nutritious formulas to use. Being a mom is tough enough—we don’t need to give anyone a hard time about not nursing.

So, when choosing a formula, what’s the best one to choose? Drum roll, please….

#1 for almost all bottle-fed babies

I’m giving the nod to one of any of the generic, store-brand, cow’s milk based products. They’re all fine. Save a few bucks for the college fund, or (even better) hire a babysitter with the extra $$ you would have spent on name-brand formula and go out to dinner without your baby. You deserve it.

Runner up: It’s a tie! All other ordinary cow’s milk formulas go here! Yay!

#1 if you’re avoiding cow’s milk for personal reasons


Any generic soy-based product, yay! The runner-up is any of the other soy products. You probably saw that coming.

#1 for fussy babies


It’s probably not the formula, you know. And it’s probably not a medical problem at all. Some babies are just kind of anxious or fussy, and need more holding and soothing. I like this guy’s approach. But if you’d like to try a formula change, feel free to try either a soy formula (which has different proteins) or one of the partially hydrolyzed products like Enfamil Gentlease, Similac Total Comfort, or any Gerber Good Start product. Don’t bother with any formula for lactose intolerance—I promise, that is not the problem.

#1 for babies with real protein allergy

These are babies with bloody stools or persistent vomiting or other health problems, and they ought to be monitored by a physician. Appropriate formulas for these babies are Similac Alimentum or Enfamil Nutramigen. Those formulas have very little role for any other babies, but are essential for babies with true allergy.

#1 for babies who spit up

If you really need to treat spit up (and usually you don’t), ask your pediatrician or family doc about adding rice cereal to the bottles—it’s cheap and easy and can reduce spitting. Or, you could try one of the “spit up” formulas (generic, or EnfamilAR or Similac Spit Up.) But I rarely recommend them.

Now I’ll take a few questions from the audience:

Do we really have to stick with one formula? What if I have coupons?

Most babies don’t care if you switch around. Save money, use samples and coupons. The taste might be a little different, but it’s not such a bad thing for babies to have to get used to different meals not tasting exactly alike.

Can I mix formula on my own, from scratch?

In the old days, before the wide availability of commercial formulas, people used to mix up baby formula with evaporated milk, added vitamins, and added carbohydrates or fats. Don’t mess around with any of that now—formulas are complex emulsions of many ingredients, and your baby will do much better on commercial varieties. Do not try this at home.

What about those follow-up formulas for babies after age one?

Traditionally, babies move to milk as a beverage at around age one, and stop drinking formulas. Often that’s a good age for nursing babies to wean. Really, there’s seldom any need for any specific “formula” other than a varied diet. Toddler formula is an unnecessary expense.

Are you expecting a Pulitzer for this series on infant formulas?

Not expecting, no. But it would look nice here next to my computer. Thanks for contacting the Pulitzer committee to suggest it!

The Guide to Infant Formulas

Part 1: What’s in formula?

Part 2: The Similac Products

Part 3: Enfamil and friends

Part 4: Gerber and the Generics

Part 5: The final recommendations

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10 Comments on “The Guide to Infant Formulas: Part 5. The Final Recommendations”

  1. Alana Says:

    I’ve said this already, but thank you so much for these posts! We needed the Nutramigen for my son, so not much wiggle room there (though we’ve recently been able to switch him to a regular milk-based formula), but it would have been so nice to hear that we didn’t have to go with the more-expensive brand name formula for our daughter. We were also told we definitely should not switch formulas! Not even when it came for free in the mail!!! Not even when it was the amazing, oh-so-convenient ready-to-feed!! Ugh.


  2. Dr. Roy Says:

    Alana, I’m not sure why so many people are so insistent that people NEVER CHANGE FORMULAS. Breastfed babies get a different taste at every meal– why would it be a problem for a formula-fed baby to change formulas? I think the “consult your doctor first” fetish helps formula companies, but probably doesn’t help families struggling to pay the bills.

    One thing though– those “ready to feed” samples. The formula companies swear that there is no difference between the powdered and ready to feed, which is an obvious lie to anyone who’s made formula from powder and compared it to ready-to-feed. Ready-to-feed has a thicker consistency, I think because of the way it’s processed and emulsified. And every once a while a bottle fed baby gets “hooked” on the ready-to-feed consistency and refuses powdered formula. In the long run, ready-to-feed becomes much more expensive (once those samples run out, and they will.) So I do see why it may not be wise to use a lot of ready-to-feed samples, especially right at first.


  3. kristin Says:

    I appreciate your blog and its overall non-alarmist tone. Well done!


  4. supermouse Says:

    My children are long past the formula stage, but I think this is great for expectant parents and those with infants, of course. A little aside, we always kept a (sealed, unopened) bottle of ready-to-feed formula in the car, in case of emergency. That’s probably a good place for the samples.


  5. Says:

    But when I say I use generic formula, people give me weird looks….:(


  6. dmdezigns Says:

    To add to the conversation on RTF, the ingredients are often different. My now 15 month old daughter has severe reflux and milk/soy protein intolerance. She was in the ER with bloody stools at only 5 days old. We started with the powder Alimentum, but honestly, her reflux is better on the RTF. Even her GI doc admits that many kids with her level of digestive issues do better on the RTF. The first ingredient in the powder is Corn Maltodextrin. There’s speculation in the infant reflux community that this contributes to the reflux symptoms and that’s why the RTF works better for these kids, although I admit it’s a small group that has this many symptoms.

    My newborn son, is throwing up much less than his sister did, so I’m hopeful that he won’t have the issues she had. And so far, we can tell a difference in the amount of throwing up (think of the body movement of a vomit and that’s what I see in 1/2 oz to 1 oz amounts rather than what I see with other babies spitting up) by switching formula. I’m not real thrilled with being on Enfamil just because I’m comfortable with similac, but it’s working for now. Thanks for the series. Last time we didn’t really have options on formula, this time it looks like we do. Appreciate the balanced approach to the different options.


  7. Jennifer Says:

    Question – my daughter 13 months old. Breastfeeding didn’t work for a variety of reasons, and the Similac Sensitive formula that the hospital started her out on gave her mucusy, bloody stools. Our pediatrician recommended switching her to soy; the issues cleared right up. Now, if she has too much of any milk products, she gets REALLY sick, so obviously dairy milk isn’t an option. Should we find a soy based toddler formula, or use soy milk, or is there a third option? Any input or advice would be appreciated!


  8. Dr. Roy Says:

    Jennifer, typically kids past 12 months of age don’t need “formula”, so you would ordinarily just move to milk. Soy milk would be fine. I suggest you talk with your pediatrician about this for advice specific for your daughter.


  9. Ankur Says:

    What about the organic ones? Earths best or similac organic


  10. stephy Says:

    This is nice to know. My baby’s pediatrician as well as wic and mihp want to keep putting such an emphasis on picking one formula and sticking to it cuz it would supposedly hurt his tummy and give him a tummy ache or something. We were looking around and trying out a bunch of different formulas cuz he had a problem with constipation. It was bad enough he was crying immediately after a bowel movement. It was pretty bad but eventually we found a mix of a soy formula and the pc brand similar to the gerber gentle pro with much more of the pc was ok. Eventually we got an automatic mixing pitcher and mostly switch between a full thing of parents choice and one with one scoop of soy with the rest as pc. There seems to be n more of that particular formula being sold by Walmart at this exact moment so I had to check to see a good generic brand to replace it but if they are all generally the same, then that is awesome and convenient and hopefully he won’t have too many issues.


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