Specialty Infant Formula Types and Their Best Uses.

The standard formula for babies who aren't breastfed combines cow's milk proteins with vegetable fat, lactose, and all the known vitamins and minerals that are in breastmilk in order for the formula to mimic not only what's in breastmilk but also to come close to providing the growth and development that breastmilk creates. As a result, two fatty acids, DHA and ARA are added to mimic their stimulate development of the brain and eyes (These are discussed in detail in another blog post).

Most babies do wonderfully well on one of these formulas, growing and thriving throughout the first year of life. But the problem, of course, is that not all babies tolerate cow's milk based formula--most of the time it seems that it's because they react to one of the cow's milk proteins. So the table summarizes the formulas that have been manufactured to solve different problems and meet different needs.

The main manufacturers are Abbott (which makes the Similac products); Mead Johnson (which makes the Enfamil line); Nestle (which makes Gerber formula and infant food); and Perrigo (which makes most of the store brands).

Type of FormulaIndications for UseNames of Proprietary Formulasa,b

Routine cow’s milk based

Similar to nutrient composition of breast milk

Term babies who are not breast-fed.
  • Similac Advance
  • Enfamil Lipil Premium, Newborn
  • Organic (Earth’s Best, Similac Organic)

Soy

Similar to nutrient composition of breast milk but with soy-protein source

Babies with milk-protein allergy or intolerance.

Babies of vegan families.

Lactose-intolerant babies.

  • Similac Isomil Advance
  • Enfamil Prosobee LipilSoy
  • Gerber Good Start Soy
  • Organic (Earth’s Best)

Rice-starch formula

Babies with gastroesophageal reflux.

  • Enfamil AR
  • Similac Sensitive for Spit Up

Intact protein with low lactose

Babies with lactose intolerance.

Similac Sensitive

Partial protein hydrolysates

Fussy babies.

  • Gerber Good Startc
  • Enfamil Gentlease

Protein hydrolysate

Partially broken-down proteins

Babies with cow’s-milk- and soy-protein allergy or malabsorption.

  • Similac Alimentum Advance
  • Enfamil Pregestimil
  • Enfamil Nutramigen Lipil

Elemental

Completely broken-down proteins

Babies with severe allergies or malabsorption.

  • Elecare
  • Neocate
  • Nutramigen AA Lipil

Preterm

Highest in calories, protein, vitamins, and minerals

Babies born under thirty-four weeks gestational age or under 5.5 lbs. These are hospital-based formulas and are not available at retail stores.

  • Similac Special Care, High Protein
  • Enfamil Premature
  • Gerber Good Start Premature 24d

Transitional

High in calories, protein, vitamins, and minerals

Babies born preterm who are ready to be discharged from the NICU.

Babies with slow growth on standard term formula or who are fluid restricted.

  • Similac Neosure
  • Enfamil Enfacare
  • Gerber Good Start Nourishd

Transitional

High in calories, protein, vitamins, and minerals

Babies born preterm who are ready to be discharged from the NICU.

Babies with slow growth on standard term formula or who are fluid restricted.

  • Similac Neosure
  • Enfamil Enfacare
  • Gerber Good Start Nourishd

aAll formula names are registered trademarks. Dr. Stan's specific recommendations for each type of type formula and more thorough descriptions are available in What to Feed Your Baby.

bVarious store brands are available; most indicate they are comparable to a brand in this chart.

cGerber Good Start varieties within this category include Gentle, Protect, and Soothe (Please see What to Feed Your Baby, for further information).

dThese formulas are 100 percent whey protein; the others are whey predominant with casein (please see the appendix of What to Feed Your Baby for more details).

Soy Formula

In the 1920s, soy was adopted to provide a nutritional alternative for babies who were milk sensitive. (See the posts on Milk Allergy vs Milk Sensitivity, and Milk Allergy and Lactose Intolerance. The formulas now have added methionine, carnitine, since both were deficient, and more minerals have been included because phytates in the soy husk interfere with mineral absorption.

The sugar sucrose is used in place of lactose and because calcium is less well absorbed with sucrose, more calcium has been added. The fat blends are similar to the fats in the cow’s-milk formulas (replacing buttermilk fats in normal cow’s milk).

The biggest controversy has been that soy formulas contain isoflavones, which are estrogen- like in their structure. However, a study done at the University of Iowa compared adults (20 to 34 years of age) who had been fed soy or cow’s-milk formula as infants and found no significant differences in growth, pubertal development, or any reproductive outcomes1.

Rice Starch Formulas

Both Abbott and Mead Johnson make formulas that contain a rice starch that thickens in the stomach to lessen gastroesophageal reflux. In these, rice starch has been exchanged for the lactose in the routine formula, keeping the number of calories and all the nutrients the same otherwise. (see our blogpost <> on the best way to use the formula and control the constipation that can accompany it. The rationale and more details can be found in chapters 6 and 8 of What to Feed Your Baby).

Lactose-free and Lactose-Reduced Formula

Lactose-free formula is essentially routine cow’s-milk-based formula with the sugar changed from lactose to sucrose. The protein, fat, vitamins, and minerals are the same, except that calcium is increased by a third because calcium is less well absorbed with sucrose than with lactose -- the major difference is the switch in carbohydrate. But lactose sensitivity is rare in infants (occurring primarily during and briefly after an intestinal infection).

Predigested Formulas (Protein Hydrolysates)

The proteins in these formulas are chemically digested (hydrolyzed) to lessen the potential for allergies and improve formula tolerance for some infants. They come in 3 varieties: either partially digested (which improves the taste and are much less expensive); those that are completely digested (which can be used for most babies with already existing allergies); and ones that have simpler fats as well and can be used for babies with specific problems of poor digestion and malabsorption. (see our blogpost on the differences in these formulas).

Elemental or Amino Acid Formulas

The protein source in these very expensive formulas is really not protein at all but the smaller amino acid building blocks for the very rare infant who cannot tolerate even the hydrolysate formulas. These budget busters (costing $500/ month) are usually for infants who have required extensive intestinal surgery or who have such severe allergies that they do not respond to the predigested hydrolysates.

Preterm and Transitional Formulas

These formulas are intended for premature babies who are either still in the hospital (the preterm formulas) or already discharged and growing at home (the transitional formulas). They too are discussed in a separate blogpost <> and in much more detail in What to Feed Your Baby.

1Journal of the American Medical Association 286 (2001): 807–14.

Mark Lorimer13 May 2015

Mark Lorimer is one of our founders, our President  and he serves on our Board of Directors. Mark and his wife are feeding one gluten- and dairy-free, seafood allergic, 13 year Read more

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