One of the great marvels of pregnancy is how a woman's body adjusts for every stage of development as it prepares for birth. This includes after the baby is born, when lactation kicks in. The truth is that even though breastfeeding is a natural part of the process, it is not easy for many reasons—be it issues with production, latching, or recovery, just to name a few. Some moms know from the start that breastfeeding is not the right choice for them, while others may start on the journey but need to transition to (or supplement with) formula later on. According to the Food and Drug Administration, an estimated 1 million infants in the United States are fed formula from birth. About 2.7 million rely on formula for part of their nutrition by three months old.
Keep in mind that the priority is doing what is best for you and your baby. Some working moms decide to switch to formula when they go back to work and can't nurse on demand. Even for those who continue to nurse and pump, it's not uncommon to find the need to supplement with formula. As babies grow and breastfeeding changes, mothers—whether they work outside of the home or not—may notice a decrease in their milk supply. (Again, this is all part of the natural process.)
The bottom line: There's no hard and fast rule, just what makes sense for you and your baby and your family at any particular time.
A Brief History of Formula
Back in the day, the only alternative to a mother's breastfeeding was a wet nurse. But that tradition was gradually swept aside as parents began feeding their babies mixtures based on animal milk. And then the first commercial formula was introduced in 1867: Liebig's Soluble Food for Babies. In the early 20th century, a doctor devised a homemade recipe based on the "percentage method," which entailed specific proportions of cow's milk, water, cream, and sugar or honey, and was later supplemented with orange juice and cod liver oil. Sounds delicious, right?
The 1930s ushered in evaporated milk formulas, which were the nutrition of choice for more than half the families in America by the 1950s. At that point, scientists had been working for years on commercial formulas that would more closely resemble breast milk. These formulas—led by the brands Similac and Enfamil—were based on a blend of vegetable and animal fats instead of milk fats. By the early 1970, about three-quarters of American babies were formula fed.
Over the years, important advances have been made in the formulations, including iron fortification, a change in the whey-to-casein ratio to more closely mimic human milk, and nucleotide and fatty acid fortification. Today, standard formulas are cow's milk-based, though there are many other varieties, including hypoallergenic, lactose-free, and soy-based formulas. Regardless the Food and Drug Administration regulates all formulas on the market. Their standards, as of September 8, 2014, include:
Current good manufacturing practices specifically designed for infant formula, including required testing for the harmful pathogens (disease-causing bacteria) Salmonella and Cronobacter.
A requirement that manufacturers demonstrate that the infant formulas they produce support normal physical growth.
A requirement that infant formulas be tested for nutrient content in the final product stage, before entering the market, and at the end of the products' shelf life.
Types of Formula
So now that we've covered the basics of formula, how do you choose the right one for your baby? The first question to answer when you're shopping for formula is: What form of it do you prefer to use: powder, liquid, or ready-to-feed, portion-sized bottles? Let's look at each type, in order of increasing convenience.
Powder: This is the most commonly used format for formula. All you need to do is measure out the powder, place it in a bottle, add the appropriate amount of water, shake until dissolved, and serve. OK, so maybe that isn't totally easy-peasy, but generations of moms have relied on powder formula to feed their babies. When you know that you'll need to feed your baby while you're on the go, powdered formula and water can be pre-measured and stored separately before you head out of the house. You can also pre-mix the formula, but keep in mind that you will need to keep it in a cooler at 40 degrees F until it's used. Once mixed and taken out to room temperature, you have between one to two hours to serve it to your baby before you need to throw it out. (Furthermore, you can keep prepared formula for only 24 hours in the refrigerator.)
As for what liquid to use, doctors recommend any tap water that doesn't have a high level of fluoride. (Large amounts of fluoride can lead to a condition called fluorosis, which affects and discolors teeth.) According to the Centers for Disease Control and Prevention, "You can use fluoridated water to prepare infant formula. However, if your baby does not eat or drink anything but infant formula that is mixed with fluoridated water, there may be an increased chance for mild dental fluorosis. To lessen this chance, you can use low-fluoride bottled water some of the time to mix with infant formula; these bottled waters are labeled as de-ionized, purified, demineralized, or distilled. If they have added fluoride, the label will say so."
Liquid Concentrate: Formula also comes in concentrated, liquid form; you need to add the required amount of water before serving it to your baby. As with powdered formula, it's essential to add the prescribed amount of water. Formula that's too diluted may not give your baby enough nutrients, and formula that's too concentrated might be hard to consume and lead to dehydration.
Because it's liquid, it's a little easier to prepare than powder; you don't need as much mixing and shaking to ensure that the formula is free of clumps. But there's still a certain amount of prep that needs to be done.
Ready-to-Drink: This is hands down the easiest version of formula for busy moms. As the name suggests, all you have to do is pour it into a bottle. Some brands make life even more convenient: all you have to do is twist off the cap and twist on a nipple that's provided. It's that easy. This option is ideal for those groggy middle-of-the-night or first-thing-in-the-morning-before-work feedings when you don't want to have to deal with measuring powder and water.
Tips for Transitioning a Breastfed Baby to Formula
If you're ready to introduce your breastfed baby to formula, it may be wise to make a gradual transition. Babies are not always eager to take a bottle. Plus, your baby may need some time to get used to the taste or any other differences from breast milk they encounter. (Some babies will be more sensitive to change than others.)
First off, you may need to have someone else introduce a bottle. Start with having dad or another caretaker offer pumped breast milk in a bottle. This will keep the taste the same while only changing the delivery mechanism. Essential to this transition is picking a bottle that your
baby will like. Keep in mind that not only do the bottles come in a variety of sizes and shapes, but so do the nipples. And the latter is key to your baby's comfort level with the bottle. Nipples are sorted by either age or flow speed. And as your baby grows and becomes capable of consuming more liquid at a time, you will need to switch to faster nipples to accommodate that.
Once bottle feeding is established, then start mixing a little formula into breast milk; maybe start with 10% formula and 90% breast milk per bottle. If your baby drinks it with no problem, keep increasing the proportion of formula until you're giving all-formula bottles. (If you're planning to continue to breastfeed and pump, you may want to keep giving your baby a mix of formula and breast milk as long as you have enough supply.) This may take a few days or even a week or more. But keep trying.
As far as finding the right brands of formula, you may need to try a few if your baby has a selective palate. Many brands advertise formulas that are designed to replicate breast milk, which would be a good place to start your search, while keeping in mind that your breast milk and your baby are different from everyone else's.
You should also watch out for signs of an allergy or sensitivity to cow's milk protein. Symptoms include rash, hives, eczema, vomiting, and blood in the stool. If they occur, check with your doctor; luckily, there are many alternatives on the market that you can try.
One added benefit to bottle feeding is that you can keep track of how much your baby is actually consuming. If you have any concerns about whether you're feeding your baby enough, this can give you peace of mind.
Both you and your baby may take some time to get used to this new feeding routine, but rest assured that you will get there. Now let's take a closer look at the best formula options for toddlers and infants.