Baby Formula: Nutritional and Safety Concerns

A new research study has found that nearly one in five respondents use infant formulas to feed their babies and that some formulas can pose significant health risks to the infant. Infant formulas were created as an alternative to breast milk and provide all the essential nutrients required for a baby’s growth and development.

This article answers the questions of when infant formula is recommended, what’s available in the US and how safe are the products.

What experts recommend

The American Academy of Pediatrics (AAP) has clear guidelines related to infant nutrition and breastfeeding that recommend exclusively breastfeeding for at least six months, or a US Food and Drug Administration-reviewed infant formula, or donor breast milk from an established milk bank.

Breast milk is best, but if this is not an option, infant formula is recommended until the baby is one year old. As solid foods are introduced after the age of six months, the need for baby formula will decrease. Generally speaking, when the baby is 12 months old, infant formula can be replaced with plain whole cow’s milk or a fortified unsweetened soy beverage. However, it is best to talk to a pediatrician for more specific guidelines.

Types of baby formula

Baby formulas are broadly classified into term baby formula, preterm formula, and enriched formulas. They are created to provide all the essential nutrients required for a baby's growth and development.

Most infants. Most infants need a basic formula for term infants like Carnation Good Start, Enfamil with Iron, and Similac with Iron. These formulas are created to mimic breast milk. They contain 20 kcal per ounce, carbohydrates in the form of lactose, and proteins from cow’s milk. According to AAP, these formulas are interchangeable and can be used to feed a baby delivered at term. There are enriched formulas such as Enfamil Lipil, Good Start DHA, ARA, and Similac Advance, which are marketed to promote brain and eye development with added docosahexaenoic acid or arachidonic acid.

Preterm babies. If the baby was delivered at less than 34 weeks gestation and has a weight lower than 1,800 grams (g) (3 lb 15 oz) the infant can be fed with a formula like Enfamil 24 Premature, Preemie SMA 24, and Similac 24 Special Care. Enriched formulas Enfacare and Similac Neosure are recommended for preterm babies delivered between 34 and 37 weeks of gestation with a weight of 1,800 g (3 lbs 15 oz) or more.

Soy formulas. Products like Enfamil Prosobee, Good Start Soy, and Similac Isomil are based on soy as a source of protein and the carbohydrates come from corn. These are indicated if the baby has a congenital lactase deficiency and galactosemia. Pediatricians do not recommend this option for babies with colic, as there is not enough evidence of the benefits.

Hypoallergenic baby formula brands Similac Alimentum, Enfamil Nutramigen, and Enfamil Pregestimil contain hydrolyzed protein and carbohydrates derived from corn or sucrose. They are indicated in babies with a milk protein allergy (as a treatment) and to prevent eczema in infants who are at high risk.

Anti-reflux baby formulas help reduce vomiting and regurgitation. According to AAP, these formulas do not affect the growth or development of the baby.

Toddler formulas Enfamil Next Step, Good Start 2 and Similac Go and Grow are based on cow’s milk and are recommended between the ages of nine to 24 months.

Goat milk and organic formulas

Some goat milk formulas like Nanny Care First Infant Goat Formula, Holle Goat Organic Milk formula, and Kabrita meet the requirements and standards set by the FDA. Parents may choose goat milk formulas if the baby has a cow’s milk allergy or intolerance. Goat milk has similar nutritional value compared with cow’s milk, but is easier to digest and may have a positive impact on gut flora.

Health-conscious parents may choose organic baby formulas from companies like Earth’s Best, Happy Baby, or Burt’s Bee. Abbott, the company that makes Similac, has an organic option. Similac Organic with Iron closely resembles breast milk and contains certified organic ingredients.

These brands and any baby formula marketed in the United States must meet federal nutrient requirements and infant formula manufacturers must notify the FDA before marketing a new formula. Organic formulas are free of sucrose or other artificial additives and often contain omega-3 fatty acids, probiotics, or other supplements.

New research study sounds the alarm

An October 2022 study featured in the Journal of Pediatric Gastroenterology and Nutrition evaluated how prevalent contemporary infant feeding practices are. These include alternatives like using an imported formula from Europe, toddler formula, homemade formula, and informal human milk sharing which are not recommended by the AAP.

The study included 2,315 participants from the U.S. Researchers found that 18% of the respondents used at least one of these alternatives. Some of these products can pose significant health risks to the baby.

Can a baby formula affect your baby’s health?

Even certified, FDA-evaluated brands of baby formula may become contaminated with bacteria or other harmful compounds at times. Recent reports found lead, arsenic, and other toxins in food products for babies and toddlers like rice cereals, juices, and sweet snack puffs. In 2022, the FDA stated plans to propose limits on arsenic, lead, and mercury in baby food.

The chances to have harmful contaminants are even higher if the formula does not meet the requirements of health authorities, or if the source is unknown. The safety of these formulas is simply unknown.

It is always best to consult with a pediatrician before changing your baby’s diet, if you are unsure about a new formula, or if your baby experiences significant symptoms related to the introduction of a new formula.