another myth...

I recommend a certain kind of formula

I don't.  And this page need updating , but the principles are sound.  i still don't recommend a formula.  If your child is under 2 months, I would seriously consider a non-powdered form as the powdered formulas are not pasteurized.

Preemies and Powdered Infant Formula warning

Buy whatever is cheapest, and has iron. Start with cow's milk based formulas and if you switch to anything else, you should chat with me. It can be confusing, and the companies that make these products are are constantly changing the recipe.  You can switch within a "class" (like cow's milk  or soy) at will.  A little formula primer:

Cow's milk based formulas:
Similac, Enfamil, Parent's Choice, Carnation Good Start, Enfamil Lipil, Similac Advance, Gentle Moments and any number of store brands. Pick whatever is cheapest.

 Despite the abundance of advertising, they are all really essentially the same, maybe a little more of one ingredient or another, but not enough that's really made any difference in any non-formula-company-sponsored study that has looked at ultimate nutritional outcome, especially when compared to breastmilk.

Carnation Good Start's "comfort protein" is really an ingredient adjustment.  Breastmilk has a certain whey:casein (protein) ratio.  Similac and Enfamil products try to mimic that ratio (which they really can't, since it changes over time) and Carnation has decided to go 100% whey.  Whey is theoretically easier to digest...hence "comfort" protein.  I don't know what happens when you remove casein from your diet.  I would guess it's in breastmilk for a reason. Carnation has less lactose, an adjustment needed to accommodate all the whey.  Lactose is important in kids...see below.

The store brands are all really basically the same formula. 

The FDA has guidelines that are minimum requirements for content in any formula on the market. All formulas available for purchase have to meet those requirements. And if you get samples from a bunch of companies during your pregnancy, you can use them all. Sticking to one brand once you've started another is not important at all.  Switch away... I do not care one hoot for brand loyalty.  Don't however, switch back and forth between soy and cow's milk based protein formulas . Actually, don't switch to soy without talking to me.

Soy formulas:
They are Isomil, Prosobee, Allsoy and any number of store brands. The kids shouldn't be on this without talking to me. If your child has some problem which is making you think that they would benefit from a formula change, we should make sure that nothing more serious is going on and that the reason for the change is actually a food-related issue. The nutritional content of soy isn't as good as cow's milk based formulas. Soy formulas are not recommended by the American Academy of Pediatrics or your pediatrician. The soy formulas all advertise that they are gentler to the stomach or are easier to digest or will guarantee your child's admission to an ivy league school or something, but really, they don't. The truest sign of formula intolerance is diarrhea, and I mean water coming out, with gas, distention and sometimes blood in the stool. The overwhelming majority of kids who do not tolerate cow's milk protein based formulas do not tolerate soy. It really doesn't help spitting up because the spitting up is from an anatomical problem and not a digestive one.  And soy formulas don't have lactose in them.  See the Lactose Free section below : lactose is important in infants.

Click here for an article about recent safety concerns with soy formulas.

Low Iron formula:
These formulas are completely unnecessary and should be removed from the market. They do not help with constipation and can cause iron deficiency anemia which can lead to learning disability and growth problems.

Lactose Free formulas: Lactose is the sugar in breastmilk. And all formulas are designed after the content of breastmilk.  Since things in nature rarely happen by chance, it's worth it to figure out why, out of all the sugars in the world, we have lactose in human milk.

Lactose helps with the intestinal absorption of calcium and iron.  It helps promote the growth of good bacteria in the gut.  And probably most importantly, it is a component of a lipid needed for brain development. Now, I don't know about the other sugars we put in formulas, other than lactose, but I think the jury is still out whether or not they do as good a job as lactose does.  Lactose is important in brain development--I'd suggest keeping it in the diet if we can.

These guys have a large market share for a problem which probably has a true incidence in kids of about 2-3% (and that's probably really generous). They are overused, mostly for "gas."  Bottom line:  If you don't have a good reason for your child to be on this, I have good reasons for them NOT to be on it.  Talk to me first.

Lactose Intolerance vs. Cow's milk protein allergy

There is an important but often confusing difference between a cow's milk protein allergy or intolerance and a lactose intolerance.

Lactose is a sugar, and it's the sugar found in breastmilk, so a true infant lactose intolerance is very, very rare. We should get lactose in the kid's diet for all the reasons I list above.

Cow's milk protein on the other hand is a protein with allergenic capability. That cow's milk protein, being a protein from another species, can cause an allergic reaction in the baby's gut. That shows up as streaks of blood in the stool. Protein hydrolysate formulas are designed for this allergy, but some kids (as many as 5-10%) will still react to even the broken down protein in the formula and need a more specialized ridiculously expensive formula called Neocate.

Protein hydrolysate formulas:
Alimentum, Nutramagen. These formulas are reserved for children with true cow's milk protein allergy and are the next choice, instead of soy, for kids who develop that allergy (again, diarrhea, weight loss, and sometimes blood in the stool). They are expensive and stinky and smell bad when they come out. Again, the decision to use these should be one we make together.  

These are being marketed as a cure for colic.  They are not.  Colic is not a gut problem!

Follow Up Formulas:

These are pretty much just a marketing gimmick.  They have extra calcium in them but even in the formula-company sponsored studies, that extra calcium made no clinical difference.  I think what happened was that the other formula companies started losing market share to Carnation Follow Up Formula, and they developed a product to help get some of the market share back.


Both AA and DHA are found in breastmilk and have been linked to improved vision and intelligence in breastfed kids.  The formula companies have long said that intellectual differences between breastfed and formula-fed kids don't exist, but now they're saying that ARA and DHA, if put in formula, will make kids smarter. 

But because some evidence shows that supplementation in formula confers maybe transient developmental benefits, we're not going to see less of ARA and DHA.  The safety of these supplements is unknown. 



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