Taking care of an infant can be overwhelming, especially if the baby is having trouble feeding. Breast milk is considered the healthiest option for infants and should always be supported. However, for a variety of reasons some infants are  fed formula. Our feeding team takes care of infants who are breast fed, bottle fed pumped breast milk, and formula fed. Our primary goal is the health of the infant and working closely with families to support their feeding goals and desires for their children.

Choosing and understanding the differences between all available infant formulas can be very daunting. Most term babies do well on standard infant formula. Occasionally, there are valid reasons to consider alternative formulas. The UNC Feeding Team and your Pediatric Registered Dietitian can help identify the most appropriate formula choice to promote both tolerance and good growth and development.

The various formula classifications and the formulas which fit within each category are outlined below. It must be known that a trial of infant formula requires the infant to be on the specific formula for a minimum of 2 weeks to determine if the formula is making a difference. The price of formula increases as the amount of predigested (broken down) proteins increase.

Preterm Infant Formulas: Preterm infants come with their own special nutrition and medical needs which causes them to fall into a special category of infant formula. These formulas have a higher concentration of calories and bone minerals. Preterm infants do not have the opportunity to build up fat or bone mineral stores prior to birth during the 3rd trimester. Most of these formulas come as 22 calories per ounce and are often concentrated further to 24 calories per ounce by the medical team.

  • Similac Neosure
  • Enfamil Enfacare

Standard Term Infant Formulas: These formulas have completely intact milk protein, which requires the infant’s body to break them down to be able to use them. Most have DHA and ARA (important for brain development), iron (necessary after 4-6 months of age as infant stores are used up) and prebiotics (to promote health of the child’s GI tract).

  • Enfamil Infant
  • Similac Advance
  • Gerber Good Start

Gentle or Sensitive Formulas: These formulas are special versions of standard infant formulas that are used when babies are gassy, spit up a lot and appear to have general discomfort. These formulas have a small amount of the whey protein broken down to help ease the workload on the GI tract.

  • Enfamil Gentlease
  • Similac Sensitive
  • Good Start Gentle

Low Lactose Formulas: These formulas are often recommended when an infant is gassy, bloated, spit ups up a lot or has frequent crying and general discomfort.

  • Gerber Good Start Soothe
  • Similac Spit Up

Soy Formula: Some families do not want to utilize a cow milk based formula. Other times, tolerance to cow’s milk protein is in question. It is important to note that more than half of the infants who are intolerant to dairy proteins are also intolerant to soy proteins.

  • Enfamil Prosobee
  • Similac Isomil
  • Gerber Good Start Soy

Extensively Hydrolyzed Formulas: These are fancy words to describe a formula with proteins that are mostly (not fully) broken down. Often milk protein intolerance is suspected if the infant vomits excessively, has lots of stomach upset with excessive gas and sometimes, diarrhea. These infants also often cry, arch with feedings and appear uncomfortable.

  • Nutramigen
  • Alimentum
  • Pregestimil

Elemental Formulas: These formulas contain 100% broken down proteins and are especially for those infants with suspected milk protein allergy. These infants are often fussy, seemingly cry in pain, have blood in their stools and/or poor weight gain. These formulas are not typically available to purchase on the shelves of a grocery store. They do not contain any intact proteins (only the individual amino acids or building blocks of proteins) that can cause allergy or intolerance reactions.

  • Neocate
  • Elecare
  • Pure Amino
  • Extensive HA

Choosing the best formula for your infant can be overwhelming and complicated. We strongly recommend meeting with a Pediatric Registered Dietitian and/or feeding specialist to discuss your concerns about your infant’s feeding before making alterations to their formula. Growth and development, infant comfort and formula tolerance are of highest concern when choosing the right formula for each infant. The UNC Feeding Team evaluates each infant seen for the milk best suited for each one – and they sure are all unique little beings!

Written by Kelly Brower, RD, LDN, CSP, one of our highly trained and enthusiastic Pediatric Registered Dietitians.