Tell me everything you know about infant formula!

September 20, 2008 4:18 PM

Tell me everything I need to know about infant formula!

First child is on her way in a few months and we'll be bottle-feeding. (Nursing is not possible for personal reasons). Trying to decide what kind of formula to use. Asked our doctor and the delivery hospital and they did not "endorse" any one over the others (although I sensed an unofficial bias towards Similac).

For those of you who have bottle fed, any advice whatsoever on the subject would be appreciated. In particular:

-Recommendations on brands / varieties? (every brand seems to have like 20 variations, its bind-moggling)
-Advice on balancing price vs. convenience between pre-mixed, powder, individual serving bottles/cans, etc.
-Tips on how to keep it healthy, safe, sanitary, fresh, etc.
-Tips on how to keep the price down
-Tips on how to keep the hassle level down (regarding mixing, sanitation, storage, purchasing, transport, etc.)
-Anecdotes on any "system" you might have developed to make your life easier in formula-ville
-etc.

Thanks in advance...

posted by Alabaster to health & fitness (29 comments total)

I nannied for a couple who had twin boys, and they swore by Dr. Brown's bottles with their formula for preventing the babies from swallowing excess air. The site talks a lot about using the bottles with breast milk but they work fine with formula too.
posted by IndigoRain at 4:49 PM on September 20, 2008

We've bottle fed our two girls and the first piece of advice that comes to mind is to ignore all the people who offer their opinions on breastfeeding vs. formula.

- The Avent microwave sterilizer is fantastic.

- Don't buy a special brush to clean your bottles. Buy a regular dish brush, it's cheaper and exactly the same thing.

- We used Similac Advanced (and also the President's Choice formula which is made by Similac) for our oldest and Enfamil A+ for our youngest. We are expecting again and we'll use Enfamil again. We went with what the hospital provided when we had each of our girls. The girls took to it fine so we didn't mess with it.

- We have used the concentrate almost exclusively. We find that it gives (our) babies less gas and less gas = happy babies = happy parents.

- When we have used powder it has usually been for outings and we took our formula in one of these. You bring your bottle with sterilized water and just add the p remeasured formula and shake. Also great for toting around cheerios when baby is on solids. With our second we used the single serving ready mades more often, but it is very expensive. We didn't use enough of the powder before it expired to make it worth doing it that way though.

- One of the great things about bottle feeding is that both mom and dad can feed and bond with baby. When our oldest was brand new I would head to bed and sleep mostly uninterrupted while Mr.Abbril had feeding duties until 3am and then it would be his turn to sleep until morning. Worked great and neither of us was sleep deprived. Unfortunately this doesn't work quite so well with baby #2 ;)

- We bought a 2 liter glass jug that was only for prepared formula. Depending on the age of baby and how much she was drinking we'd either prepare one or two cans of concentrate at a time and pour out up to 8 bottles so that they were ready to go when needed. Horror of horrors, we microwaved the formula to heat it. We gave it a good shake (usually) and never (knock on wood) had any troubles. Heating it in water is a PITA and takes forever at 3 am with a hungry, screaming baby waiting.

- Don't stock up on formula before baby comes, wait and see what s/he will drink first. Once you know what s/he'll take buy as much as you can when it goes on sale. Watch for sales. Oh, and all the companies give out samples if you request it online or by phone.

Congrats on the baby!
posted by Abbril at 4:50 PM on September 20, 2008

We kept the price down by buying the big canister of powder. We didn't have a choice in brand. We had to use Nutramigen for health reasons.

We used the bottle system with disposable liners. I felt this was most sanitary. When we were out and about for the day, we would sterilize a few nipples and seal them in Ziploc bags. We would also put some powder and measuring scoop in a Ziploc so we didn't have to carry the whole canister with us. I found it pretty easy to mix the powder and hot water right in the bottle. About a minute of vigorous shaking was required, so it may not be the right solution for everyone.

For night feedings, I pre-made a couple bottles and kept them in the refrigerator. I would warm the bottle by running hot water over it, which I found easier to do at 3 in the morning than vigorous shaking.
posted by Fuzzy Skinner at 4:57 PM on September 20, 2008

I had no problem with the powder varieties. We used Enfamil Lipil, which is expensive but seemed to have a good reputation. I kept the cost down by shopping at the Big Box or getting a case online. 1-800-diapers has good prices. And start collecting coupons now. My son grew like a weed if that's a recommendation. Just pay attention to the mixing ratio. At some point in his first months, I realized that I'd accidentally been shorting him by putting half as much formula in as I was supposed to when we changed bottle sizes. Whoops.

We had some of the pre-mixed nursette bottles at first, got them at the hospital when he had jaundice. They are very convenient when you're on the go, but too expensive for me. I switched to keeping a a few ounces of powder and a scoop in a small tupperware container. Don't use baggies for this. They will invariably leak, and cause you to have to throw away the diaper bag. If I knew I'd be in the car or away from a source of water, I'd include a small jug of water too.

One thing that will help you, is trying to get a good sense of when the baby is hungriest. You don't want to see that bottle emptied to the last dregs, and then have to get up and run to the kitchen to make a few more ounces.

Good luck!
posted by saffry at 4:57 PM on September 20, 2008

Avoid DHA. This is worth reading. Also.

There are a lot of interesting books on baby milk; Mothers and Medicine: A Social History of Infant Feeding, 1890-1950 by itself should leave you particularly well-informed. I would not ask the average doctor for formula recommendations; there is no basis for claiming any one milk-based formula to be superior to any other. There are theories, but, as with the DHA, a lot of the theories turn out to be bad ideas.
posted by kmennie at 5:24 PM on September 20, 2008

Seconding the microwave sterilizer. It's great.
posted by fshgrl at 5:36 PM on September 20, 2008

yikes kmennie! from the price link:

The ideal milk for baby, if he cannot be breastfed, is clean, whole raw milk from old-fashioned cows, certified free of disease, that feed on green pasture.

I'm not a baby scientist or anything, but that's *horrible* advice.
posted by moxiedoll at 6:07 PM on September 20, 2008 [1 favorite has favorites]

Medela makes these bags that you can use in the microwave to steam sterilize nipples and pacifiers and such. Each bag can be used 20 times. They were FABULOUS!! Babies r us carries them.
posted by pearlybob at 6:43 PM on September 20, 2008

Once the baby comes, ask your pediatrician for formula samples every time you visit. My good friend is a pediatrician and she says they have tons of samples and they want to give them to you but often forget to offer. So ask, every time you go. Also, if you belong to a warehouse club like Sam's or Costco, see what they sell and consider using one of those brands. I think you'll save some $$$ by buying in bulk there, once you know what the baby likes/tolerates. I'd just start with what the hospital gives you and if that goes fine, stick with that. Congratulations on your soon-to-be bundle of joy!
posted by Kangaroo at 7:06 PM on September 20, 2008

We supplemented breastfeeding with formula for nearly a year.

After trying several brands, we ended up with the generic organic formula from Walmart. $10/can cheaper than Similac & the nutritional stats were the same.

If you sign up on baby websites or the formula sites, they'll send lots of coupons. I've heard that if you say you're planning to breastfeed or aren't sure, that they'll send more than if you've made up your mind. Don't know how true that is, but we sure got a *ton* of coupons.

We used 4oz Playtex Nursers bottles with the disposable liners. The generic liners from Target/Walmart work fine. For traveling, drop the scoops of formula in & put on the nipple. Just bring along a bottle of water & add it when it's time to eat. Shake & you're done.
posted by belladonna at 7:13 PM on September 20, 2008

Yikes again, kmennie. The "avoid DHA" link is to a 10 year old article. Most doctors I know favor DHA & ARA in formula. Way too much info on the composition of infant formula here, for those who want a reference. Short version: international group of doctors recommends a minimum amount of essential fatty acids (DHA,ARA) in formula.

Formula is FDA regulated so cheap brands are pretty much the same as expensive brands. The FDA even has an infant formula FAQ.

These enfamil powder sticks rock the house. They are single serving packs of formula, so easy to use when you are out of the house. After one trip shlepping around a heavy bag of premade bottles - plus the ice pack need to keep them at fridge temperature - you will learn to love these. You can carry around a couple of formula sticks and an empty bottle and make up formula when you need it.
posted by selfmedicating at 7:32 PM on September 20, 2008

We're using both breast milk and formula - all fed from bottles since my daughter refuses to breast feed and I have a low supply. We started out using Nutamagin because that's what the hospital gave us but it's super smelly and when you start getting baby spit up everywhere (and you will), the odor is disgusting.

We switched to Good Start Supreme in the powered format. I guess the pre-made version would be easier but it's never seemed all that difficult to mix my own. Since the amount of formula we need per bottle is slightly variable, we usually make up a batch of about 14 oz every day and store it in a thermos in the frig. After powered formula is mixed, you're only supposed to keep it for 24 hours so we just use that to pour into bottles (we use Born Free) as we need it, mixed with whatever breast milk I've pumped. I do prefer to use BPA-free bottles.

We hardly ever bother with sterilizing the bottles, instead we use hot soapy water after each use and maybe every 3-4 weeks I sterilize them. We also use tap water and never heat it up. She drinks it straight from the frig cold. At three months out, my daughter seems to be doing just fine with our system.

Basically though,all formula is nutritionally identical. They may have a few twists here and there (the DHA thing or probiotic cultures, etc) but if you're in the US, the FDA regulates all formula to have the same nutritional profile. So whatever formula your baby ends up liking due to taste or whatever, that's the one to use.

Good luck!
posted by otherwordlyglow at 8:04 PM on September 20, 2008

We bought Similac until we discovered that Costco sells essentially the same thing under their Kirkland brand and it's only $19 for two giant cans. We load up when we go and it lasts forever. I also like to buy an extra two-pack to donate to a shelter...can't imagine having a baby and worrying that I couldn't afford to feed her.

We use powder now and mix up a pitcher at a time, but when she was new, a lifesaver was finding out that Similac sells individual bottles that you can just pop a nipple on. Kept a six-pack (!) in her nursery (it doesn't need refrigeration, tho we had a little fridge in there too) and a few bottles in the diaper bag and it saved our sanity many times.

Gerber bottles with the green, blue or purple tops were/are the only ones that work for us. Hated the ones with the bag liners.
posted by GaelFC at 10:02 PM on September 20, 2008

I had to use formula to supplement for my son for a while. The research I did (and anecdotal evidence from others) suggests that really there isn't any difference between brands, other than taste and price. The exception is with the hypoallergenic formulas like Nutramigen and Alimentum, which are for babies that cannot tolerate the milk proteins in regular formula. There are also soy-based formulas for babies with cow's milk intolerances. So assuming your little one does not have any allergies, then pick whichever one you like.
posted by Joh at 10:05 PM on September 20, 2008

Nthing the Avent sterilizer. We used the Avent bottles as well and really liked them.

As everyone has said, there's really no difference between most formulas. My doctor said not to switch back and forth between formulas as it's not good for baby's tummy, so once you find a cheap one that baby likes, stick with it.

We used powder almost exclusively. If we were going somewhere, we'd bring a bottle of really hot water (it would cool down to warm by the time we needed it) and bring the formula separately in the little container someone else mentioned.

Every morning we would take as many bottles as we needed for the day and fill them about 1/2 way with water. We'd keep a hot water urn going at all times, so when it was time for a feeding we would just add a few ounces of boiling water to the cold water, making it the perfect warm temperature. Then we'd just add the formula and voila!

Your baby doesn't NEED the formula to be warm (the nurses in the hospital used cold formula right from the fridge and said it was fine for baby's tummy). The only reason we wanted it warm was to make it easier for the powder to dissolve.
posted by bluekrauss at 10:35 PM on September 20, 2008

My kids all vomited a bit more with formula than they did with breast milk. This is a slight problem, because barfed-up formula stains fabric like you wouldn't believe. I took to always placing a cloth diaper or towel over them during and after feeding so I wouldn't have to worry.
posted by Waldo Jeffers at 1:59 AM on September 21, 2008

A friend of mine formula-fed her daughter, and her pediatrician said that if the kid didn't have issues with gassiness or fussiness to just buy whatever formula was on sale...if money was a problem, brand loyalty wasn't necessary. You might want to check with your pediatrician to see if he or she has the same philosophy.
posted by christinetheslp at 5:23 AM on September 21, 2008

Develop a thick skin or a witty response to breast milk advocates. Don't expect common decency to always prevail. Pregnancy and newborns seem to bring out extreme and vocal opinions in people. Don't let friends, coworkers or strangers make you feel bad about your decisions!

Watch for mastitis.

Good luck!
posted by beachhead2 at 6:55 AM on September 21, 2008

Also - Once you settle on a brand, try to buy in bulk. But, don't buy ahead until you are certain brand x won't cause tummy upset!
posted by beachhead2 at 7:09 AM on September 21, 2008

"Formula is certainly theoretically more appropriate for babies than cow's milk. But, in fact, there are no clinical studies that show that there is any difference between babies fed cow's milk and those fed formula. Not one." *

Fresh milk, modified, was infant formula before big pharma started pushing the idea that it's better if it comes in a can, pre-modified for you. No. So long as you avoid known pitfalls re. vitamin deficiencies, modified cow's milk is as good as any commercial formula. I would think parents would have even more of an open mind about who's best qualified to mix their baby's formula given recent news stories about recalls in China. Commercial formula is just modified cow's milk itself; there's nothing magical about it.

The "ten-year-old article" where DHA is associated with a negative outcome is a study done in part by "Ross Products Division, Abbott Laboratories." (tr. Similac.)
posted by kmennie at 8:52 AM on September 21, 2008

Brand doesn't matter, different babies like different brands better, so keep an open mind. If one doesn't work, switch to one that does.

Start with the cheapest.
posted by sondrialiac at 10:42 AM on September 21, 2008

I don't really want to continue the derail but I do think kmennie's statements need refuting. The American Academy of Pediatrics recommends waiting until a child is a year old before starting her on fresh cow's milk to reduce the risk of an allergic reaction, prevent anemia, and reduce chances for dehydration. You can certainly choose to forgo formula, but there are risks.
posted by otherwordlyglow at 11:01 AM on September 21, 2008

Not unadulterated, unmodified cow's milk.

Enfamil Lipil ingredients: "...Nonfat Milk..."

Also of interest: The Canadian Paediatric Society says it’s fine to introduce cow’s milk between nine and 12 months of age. However, in the US and some other countries, the official advice is to wait for at least a year. Why are the guidelines different from those in Canada?
posted by kmennie at 11:12 AM on September 21, 2008

No one is claiming that most infant formula isn't milk-based. Unless it's soy formula, it's made from cow's milk. From the Mayo Clinic:

Most infant formula is made with cow's milk that has been altered to resemble breast milk. The alteration gives the formula the right amount of carbohydrates and the right percentages of protein and fat. The alteration also makes the formula easier to digest. Remember that regular cow's milk isn't a substitute for infant formula. Pasteurized goat's milk and evaporated milk aren't either.
posted by otherwordlyglow at 11:42 AM on September 21, 2008

We buy powdered Good Start formula and mix it in an old Classico pasta sauce jar; it has gradients marked by ounce on the side so it's easy to mix. We use Dr. Brown's glass bottles. We've never sterilized anything, though we do make a new batch and wash the jar every day.

We heat it slightly by running tap water very hot and setting the bottle in a bowl of the hot water for a minute or two--it winds up being tepid to warmish. On hot days, we give it to her slightly cooler, on cold days, we let it get a little warmer.

When we go out, we measure one serving of formula in a couple of Ziploc bags, then we take one empty bottle and a bottle full of room temperature water so we can mix and go if she gets hungry.

Our physician told us just to care for her food and the associated paraphernalia as we would our own and so that's what we do; her stuff is clean and fresh but not obsessively sanitized. She seems happy and has no weird digestive problems. If her immune system were compromised, or if she were underweight I might be a little more concerned, but she has always seemed very strong and healthy to me.

Reading these answers over, it seems like you get quite a spectrum of opinion--as with a lot of baby decisions, you'll do it the way that makes most sense to you, that's in line with how you already see the world. If I were a germ-minded person, I'm sure I'd be more concerned with sterilizing and so on, but our whole house is covered in dog and cat hair and mud we've tracked in from outdoors and she spends a good amount of time getting face-washed by the dog, so efforts to keep her world a sterile one aren't going to amount to much.
posted by A Terrible Llama at 12:15 PM on September 21, 2008

Good for you for starting the research early!

I have a four month old. We started with Neosure because she was premature and needed the extra calories. That started to upset her stomach when she took it straight (we also used it to mix in with breastmilk to add more calories), so we switched to Enfamil Gentelease. That was no good, so we went to a soy formulation. Bad idea. That was even worse. Now we use Similac Sensitive and it's been awesome.

You should give the formula about a week to see if it's agreeable with your baby. If you have a lot of crying during feedings, baby is making her body stiff, arching her back or is burping up/spitting up most of the feeding each time, try a different type. If your baby cries a lot at night, try a different type. (Most babies will get cranky toward the afternoon, but if it's screaming-crying, try switching formula; it might be tummy discomfort and you might get success by switching. That's what happened for us.)

Sign up on the Web sites for coupons and definitely get the goodie bags at the hospital and at the doctor's office. Ask your family to sign up for coupons, too; they don't check ID when using formula checks. It's my experience that Enfamil sends checks more often than Similac does.

As for pricing... personally, I think it is a price racket because I never see Enfamil lower than $24 for a big can and Similac regular for less than $25 for a big can. I know Costco has some better prices on different sizes, but for regular retail, that's about what you'll pay everywhere, between $23-29 for a big can. So get the formula checks and clip the (scarce) coupons that come around. I have used Drugstore.com and diapers.com to get better deals occasionally. Check the Baby Cheapskate blog for the best deals every Sunday.

I don't use generic or store brand because the stores I shop at on a regular basis do not have a sensitive formulation. I know Target does, but I don't shop there. But, I have heard good things about all the store brands of formula. It is required to meet strict FDA nutritional standards, so you can compare apples-to-apples; what you can't compare is taste, or know what your baby likes until you try it.

Good luck and congratulations!!!
posted by FergieBelle at 12:21 PM on September 21, 2008

Yes. You can "alter" milk at home. Nothing magical happens in factories.

What Every Parent Should Know About Infant Formula: "...Contrary to what the name implies, there is no fixed "formula" for commercial synthetic milk."

It's not as though Enfamil or Similac or whomever have a lock on the perfect recipe. You end up with bind-moggling variations on the same theme because that's what sells, slapping on a "for fussiness or gas" tag. New mothers are easily worried; just as breastfeeding mothers sometimes imagine they have insufficient milk, bottlefeeding mothers are also prone to "not enough" fears, which is why "extra hungry" milks are out there. The variations are variations in marketing, not science. The recipe is anti-scorbutic, anti-rachitic, but really not standardized. Why?

"Just adding something to formula, even if it is in the same amounts as in breastmilk, does not mean that the baby will get the amount or the best sort he needs of this particular something. The example of iron helps us understand this. Breastmilk contains enough iron (with the stores the baby has during pregnancy), to keep the baby iron sufficient for at least 6 months. To maintain iron sufficiency in formula fed babies, formula needs to contain at least 6 times more iron than breastmilk, just because iron does not get absorbed from the baby’s gut as well from formula as it does from breastmilk." (link)

While I would not go so far as to recommend the "formulas" for homemade formula that were offered in early editions of Dr Spock, there really isn't any sound evidence to recommend them over "Enfamil Lipil" or any other commercial product. The 1998 edition of the AAP's own "Caring For Your Baby & Young Child" even offers a recipe and claims that 5 to 10 per cent of new mothers make their own. Pediatricians have a long history of recommending this or that formula for this or that reason, mostly thanks to the need to advance the new field of pediatrics or thanks to the Nestle rep who dropped by with new "information." It is good for the AAP, not so good for babies.

(Trivia for the curious: "Rotch emphasized a need to have feedings that were both chemically sound and individualized to a specific child. He developed a complicated "percentage system" to modify the chemical composition of his milk formulas to meet what he believed were the day-to-day changing requirements of an individual infant. It should be noted that the reason the word "formula" is still used by American pediatricians to describe infant feedings is because of Rotch’s percentage system." via the AAP. The BS still goes on today; the "AAP believes that ads promoting starter infant formula directly to the public and not to pediatricians are "inappropriate."" {link})

Given the current Chinese baby milk scandal (not a problem limited to China) homemade formula should not strike anybody as radical.
posted by kmennie at 1:17 PM on September 21, 2008

Alabaster, Look at the debate above and you'll see what you can expect. People get so sure that their opinion is the only correct opinion for your baby.

The best advice I can offer you is to listen to your baby and your doctor. Every baby is different. Remember it's not just spitting up and gas; it's muddy diapers too. Iron made one of our girls hopelessly constipated. You really, really don't want that.

Unbelievably, babies are durable. Lots of babies seems to be thriving on all types of formulas and on breast milk.
posted by 26.2 at 3:59 PM on September 21, 2008 [1 favorite has favorites]

First of all, congratulations on your impending baby. All the best for a happy and healthy family!

When you first have the child, the hospital will probably provide some formula for free. The major formula companies (mainly Similac and Enfamil) give them cases of it, free diaper bags stuffed with coupons, etc. to give out to new parents. The companies know that most parents will just go on and keep buying the same brand that they start the baby on; they may feel like it's unsafe or unwise to change brands, even, since the hospital sort of "blessed" the brand they first used. Well, it's okay and it's safe, you can try other brands. Baby formula is pretty well regulated and there are stringent guidelines they all conform to, so any baby formula in the US is going to provide nutrition to at least that standard. Plus, if you read an old Dr.Spock baby book from the 1960s, you'll see that people used to make their own formula out of canned evaporated milk, corn syrup, and water - nobody would recommend that now, but I've met people who were raised on that as babies and turned out healthy and fine!
With this as with so many things, you just need to find what works well for your baby and your family, and blow off everything and everyone else.

Our kid had a little trouble with some formulas, and some friends recommended the Wal-Mart store brand, which worked great for us. We read the labels and figured out that the Wal-Mart store brand ("Parent's Choice") was the same as the Albertsons, Target, Kroger, and several other store brands; they were all made in Georgia, Vermont by PBM Nutritionals. They also sell it directly now (in some stores and online) as "Bright Beginnings" and have come out with an organic line, sold with the same branding or directly as "Vermont Organics," if that appeals to you. It's a less expensive product (which we often found on sale as well), easy to find in a lot of stores, and they have a lot of information online about their company, products, and practices. So I do recommend it as worth a try, although I don't think you'll get free samples or coupons from the hospital/pediatrician. You can request free samples online, if you like, via the Parents' Choice web site.
We used the regular milk-based variety, which did have DHA and ARA added. I had some concerns about soy phyto-estrogens affecting my son, although it's not clear to me whether they are really a problem. Plus, my husband and I are both of northwest European descent and able to digest milk as adults, and we aren't vegetarian or vegan or anything. So milk-based was the easy choice for us. If you have concerns or cultural/personal issues about soy or milk, definitely discuss them with your doctor.

We also used Avent bottles, although bottle choice really depends on what works for you and the baby. We also had some Medela bottles with a highly engineered nipple that confused us and the baby, so hey. We never sterilized bottles or anything; we just ran them through the dishwasher (using those little rack things for all the fiddly bits). We used plain, unfiltered tap water, although we did live in an area with excellent tap water (greater Olympia, Washington, USA - tasty artesian well water). We always fed him the formula at room temperature, as we felt that would be easiest.
So when heading out somewhere, we would pack the diaper bag with bottles filled with pre-measured water and formula dispensers filled with pre-measured formula powder. Always bring more than you think you'll need!
When we went to bed at night we set up for night feedings: we laid out several bottles on a tray filled with pre-measured water, powdered formula pre-measured in a formula dispenser, and a small lamp so we wouldn't have to turn on too much light (something on a dimmer switch would be great). So when the kid wanted feeding, we would turn on the lamp, take the top off a bottle, dump powder into the bottle, put the top back on, shake, and feed the baby. That's harder than it sounds at 4 am, and we found some dispensers easier than others.

Hope that's helpful to you, and again, best wishes.
posted by ysabella at 6:52 PM on September 21, 2008