Formula and Infants

Children under the age of 12 months should be given either breast milk or infant formula to drink.  When formula is chosen, it should contain everything needed to allow for the infant’s growth and development.  In the United States, all formulas labeled for infants under the age of 12 months are FDA approved, and will provide a child with adequate nutrition. 

Choosing a formula

Most infants do very well on a cow’s milk based formula with added iron.  Only a small number of children need to switch from this basic formula.  All cow’s milk infant formulas are equally good at making a child grow and develop normally, and all are FDA approved.  Many families ask about using the newborn specific formulas, formulas for supplementation, organic formula, or ones with added DHA. The answer is that none of these have been shown to be better in general, and often cost more.  If the generic brand fits in your budget better, you can feel confident about giving it to your baby.

Also, because most infants do equally well on all the cow’s milk formulas, you can buy the one on sale.  Save the extra money because children cost a lot! 

If cost of formula is a concern, the Women, Infant and Children program may be right for your family.  They help with the cost of the formula.  In addition, if your child has a medical condition which requires a specialized formula (usually very expensive), the insurance program for children with special needs in the state of Michigan (CSHCS) may be right for your family.  Ask your primary care physician about these programs if you need more information.

Formula Type Examples of Brands Reasons to Pick Special Notes
Cow's milk formula with iron Similac Advance, Enfamil Premium, Gerber Good Start or store brand (ex. Target, Meijer, Costco) Generally formula of choice and provides good nutrition to most infants No evidence of improved outcome from added DHA, but do not harm an infant (brand examples: Enfamil Lipil or Good Start DHA)
Soy milk formula with iron Similac Soy Isomil, Enfamil Prosobee, Gerber Good Start Soy or store brand (ex Target, Meijer, Costco) Desire for vegan diet, Galactosemia, Congenital Lactase deficiency Not appropriate for preterm infants, no evidence they help with colic
Cow's milk formula with iron and added thickener (by use of added rice starch) Enfamil AR and Similac Senistive RS When recommended by your physician for some infants with GERD  
Formulas for Preterm infants Enfamil 24 Premature, Similac 24 Special Care, Enfacare, Similar Neosure When recommended by your physician for some preterm infants More costly and not needed for all preterm infants
Hypoallergenic and Non-allergenic formulas Similac Alimentum, Enfamil Nutramigen, Elecare, Neocate, Nutramigen AA Milk Protein Allergy or other rare diseases Expensive and growth needs to be watched carefully because some infants taking these formulas do not grow well.  Make sure to speak to your doctor about this option before starting.


Preparing formula

There are three types of formula preparations to buy, the difference between them being cost and convenience.

  • Powdered formula: Least expensive, takes time to make. To prepare, measure water into bottle first.  Clean cold tap water is fine to use, although if you prefer you can use bottled water that contains fluoride.  Add the formula in level scoops and stir.  Always use the scooper that comes with that container of formula.  In general, measure 2 ounces (60mililiters) of water for every scoop of formula (unless directed otherwise by your physician). 
  • Liquid concentrate: More expensive, but you just add water to the concentrate so it is faster to prepare.  To prepare, add clean cold tap water per directions on bottle.  Usually, you add equal amounts of water and formula concentrate.
  • Prepared ready to use: Most expensive, but ready to feed and requires no mixing.  Convenient for times you are traveling or want quicker availability.

Additional tips for preparing formula:

  • Always use cold tap water as it has fewer contaminates in it.
  • Never warm in microwave.  An easy way to warm a bottle is to put warm water in a coffee mug and set the bottle in the mug for a few minutes.  Swirl gently to mix.
  • There is no need to boil water first, unless advised by the local government or your doctor.
  • Infants need fluoridated water for dental health, so if you are not sure your water has fluoride, speak to your physician.
  • Once the baby’s mouth touches the bottle, formula should be used within 1 hour or thrown away.
  • If the baby’s mouth has not touched the bottle, formula can be stored for 24 hours in the refrigerator once it is prepared or opened.
  • All formula types have an expiration date, so make sure to look before giving to baby.

Weaning from formula

Infants should not be weaned from formula until 12 months of age, to allow for appropriate growth and to prevent anemia.  However, at 12 months, your infant is now transitioning to a toddler.  Bottles should be replaced with cups, and formula can be transitioned to whole milk, unless advised otherwise by your physician.

There are many ways to make this transition, but as with most things in life, the simplest way usually works well.  To transition, put a few ounces of whole milk in a cup and give it to your toddler.  Slowly cut out the formula you give as you increase the whole milk.  It is best to start to give milk only with meals and snacks to protect your toddler’s teeth from cavities due to the milk sugar. 

Most children do fine with this transition and there is no need get more complicated than putting the milk in a cup and taking away formula bottles over the next few months.  However, some children have a very strong preference for a bottle or a strong dislike for whole milk.  Talk with your doctor about ways to help with the transition, if this is the case.

Tips for weaning formula:

  • Always put milk in a cup and formula in a bottle.  This way as you wean bottles, you wean formula.
  • Make sure you can drink from the sippy cup you give your child.  To prevent spills, some cup manufacturers have made the cups so much work to drink from that the child gives up.  If your jaw hurts drinking from the cup, take the valve out or pick a new one.
  • Give milk with meals or snacks and water in between to protect your child’s teeth.
  • Make sure your child is getting enough fluid during this transition.  If their poop starts to get hard, offer them more frequent water from a cup. 
  • Children do not need juice.  It harms their teeth and does not provide better nutrition.
  • Do not let your child walk around with a cup.  They fall a lot and injury to the gums and teeth from sippy cups can injure their adult teeth. 
  • Most children do well with 16-24 ounces of whole milk daily.  If your child is outside this range, make sure to speak to your doctor about it.

Reviewed by Gwen Zirngibl, MD

Updated June 2017