Deciding which formula is right for your family means considering your baby's health, age, and dietary needs, as well as each formula's cost and preparation time. Whichever one you opt for, you'll be choosing between two basic types: milk-based and soya-based. Here's what you need to know:
Milk-based formula
Most infant formula milks are based on cow's milk, which is modified in order to resemble breastmilk as closely as possible. Manufacturers modify cow's milk for human babies by adjusting carbohydrate, protein, and fat levels and adding vitamins and minerals. There are also special types of formula manufactured for premature babies. The quality of traditional infant formula has improved tremendously in the last decade. However, researchers have yet to reproduce the unique qualities that make breastmilk the ideal food for babies.
1. Whey based formula, often called “first” milk
Whey based milks have nutrients, protein, vitamins and minerals in similar amounts to that found in breastmilk. There are slight variations in composition between brands, although all are similar and adequate for your baby.
Available brands:
• Cow & Gate premium*
• SMA Gold*
• Farley’s First*
• Milupa Aptamil*
• Boots Infant Formula One
• J Sainsbury First stage
*Please note - Milks marked* are available at the hospital
2. Casein based formula, often called “second” milk
The type of protein in casein formula is quite different to that in whey formula.The casein milks are ‘older fashioned’ types of milks, designed when this was the best the processes could do to modify cow’s milk. These casein milks are advertised as being ‘more satisfying’ or ‘for hungrier babies’.
There is little evidence to support this. Introducing casein milk before six weeks can overload the baby’s developing kidneys. Some babies develop constipation when the milk is switched from whey to casein base.If your baby seems hungry after feeds, you may wish to offer more frequent whey based feeds with a larger quantity of milk rather than switching to casein formula.
Whey based or ‘first’ milk should be used from birth until the end of the first year and there is no need to change from your first choice of formula at a later date.
Available brands:
• Cow & Gate Plus
• SMA White
• Farley’s Second
• Milupa Milumil
• Boots Infant Formula Two
• J Sainsbury Second Stage
You will see that each of the companies makes a whey based as well as a casein based artificial formula. The casein based formulaes are also manufactured from cow’s milk.
3. Follow-on formula
These artificial milks are not necessary and should not be given to babies less than six months of age. The milk companies advertise that these formulas have added iron, but all whey and casein formulas have added iron, and there is no need to change.
Available brands:
• Cow & Gate Step-up formula
• SMA Progress
• Farley’s Follow on formula
• Milupa Forward
• Boots Follow-on formula
• J Sainsbury Follow-on milk
When to use cow’s milk
Pasteurised whole cow’s milk should only be used as a main drink when your baby is over one year of age.
Semi-skimmed milk should not be used as a main drink before the age of two years. If your baby is growing well and eating a wide range of foods, semi-skimmed milk can be introduced after your baby’s second birthday.
Fully skimmed milk should not be given to children under five years of age.
Soya-based formula
Soya-based formula*(see below) is made from soya beans which, like cow's milk, are modified for use in formula with vitamins, minerals, and nutrients. Babies should only be given soya-based formula on the advice of a health professional, such as a health visitor, GP or dietitian.
Babies who have a cow's milk intolerance or allergy** (see below) should be referred to a dietitian, who may recommend a soya-based formula or a cow's milk-based formula which has been specially modified for babies with an allergy or intolerance. However there are also many modified cow's milk-based formulas that are suitable for most babies with an allergy or intolerance, and some babies who are allergic to cow's milk are also allergic to soya.
There no evidence that changing to a soya-based formula can help soothe a baby is unsettled or colicky.
Available brands:
• Most manufacturers produce a soy based formula
*Soya-based formula Government recommendations suggest you only give soya formula to your baby on the advice of a health professional, such as a dietitian, health visitor, paediatrician or GP. It is not recommended for babies under six months.
Soya formula may be suitable for your baby if he has a cow's milk allergy or intolerance. But there are also lots of modified cow's milk-based formulas that are suitable for most babies with an allergy or intolerance. Make sure you seek medical advice on this to ensure your baby gets the best possible alternative to breast milk.
Soya formulas contain glucose syrup, which can damage your baby's teeth with prolonged contact. To protect your baby's teeth:
• do not allow your baby to sleep with a bottle in her mouth
• transfer her to a feeding cup from around six months
• start cleaning your baby's teeth thoroughly and regularly as soon as her teeth appear.
Dental care is free for children so make an appointment for your baby to see a dentist regularly and make sure you tell them your baby is having a soya formula.
Some parents also have concerns about the presence of phytoestrogens in soya formulas. Phytoestrogens are oestrogen-like substances that occur naturally in many plants, including soya. There is some concern that a large intake of these could have an adverse effect on babies' hormonal development. This is a controversial issue which is yet to be resolved and agreed upon by the experts. However, the Food Standards Agency advises that, until a full review of the evidence both supporting and opposing soya formula has been completed, soya formula should only be given to babies under 12 months in exceptional circumstances and should not be the first formula of choice.
Reviewed March 2006
**Cow's milk intolerance is an intolerance to either the protein component of milk or to lactose, which is a naturally-occurring sugar found in cow's milk. A lot of confusion exists between the terms cow's milk allergy and intolerance, and they are often used interchangeably.
Cow's milk protein allergy is a true allergy that can be detected by a blood test and/or by a simple procedure called a skin prick test, both of which are available on the NHS. If your baby has a true cow's milk protein allergy, you will need to exclude cow's milk and cow's milk products from his diet completely.
Cow's milk protein intolerance is not a true allergy and will not give a positive result in the blood or skin prick test. However, it is essential that investigations are done to determine whether cow's milk intolerance is to the protein or the lactose in milk. If your baby is diagnosed as having an intolerance to cow's milk protein he may still be able to have some cow's milk and milk products in his diet.
The symptoms of lactose intolerance are caused by undigested lactose passing into the colon. It's caused by a deficiency or absence of lactase, the enzyme that digests milk. Your baby may be put on a low-lactose diet which allows low-lactose milks and milk products. Some babies can tolerate certain amounts of high-lactose foods before they show any symptoms.
Two to six per cent of babies will develop cow's milk intolerance or allergy, and symptoms may include being unsettled, persistent crying, weight loss, failure to gain weight, malnutrition, reflux, vomiting, colic, burping, flatulence, bloating, diarrhoea, constipation, eczema, skin rashes, and shortness of breath. Many will grow out of it by the age of three, and most will have grown out of it by the age of five.
If your baby has any of these symptoms, it is essential that you see your GP so that she can make a proper diagnosis. If she suspects your baby may have cow's milk intolerance or allergy, she will refer you to a dietitian for further investigations and advice.
Reviewed March 2006
The information above is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.
