Which formula is best for my baby?

“Which formula is best for my baby?”

Has been the question mostly asked by moms in our community since our launch in September 2020. 

Our short answer would be: “The best formula for your baby is the one that makes you and your baby happy.”

However, as moms, who had been there ourselves before, we know that to get to that happy place there is a process involved. This process can be pretty overwhelming but it doesn’t have to be, depending on how we approach it.

We should warn you at this stage that there is a lot of information to take on, so this reading might have to happen in a few sittings:)

Process of choosing the right formula - how to approach it?

Before we even start researching different formula products on the market we should first ask ourselves what our reasons are for choosing baby formula and what is important to us when choosing a formula product.

“After three months of breastfeeding, constantly battling with my milk supply, multiple visits to lactation specialists, countless milk production enhancing supplements and my son still not gaining optimal weight I finally listened to the advice of the baby clinic nurse to try to supplement my breastmilk feeds with formula feeds. Although I didn’t know what options are available on the local market I was very clear I wanted to find an organic formula product for my son. At the time my reasoning was that if I have to supplement with formula it must be organic as what else could be as close to breastmilk if not organic….?! Based on the advice of the baby clinic nurse I tried an organic option, which my son took to very well. Subsequently I switched to another organic brand a few months later when I was no longer breastfeeding. My decision at that time was based on the research I did on both organic products available on the market. Both were equally satisfying, so after consulting with my baby clinic, at the end the price tag was the deciding factor.” - Kasia Bergh, MyMilkClub founder.

To put things into perspective - when your choice is an organic formula product you immediately cut out 90% of other baby formula products available on the South African market so this makes the process pretty easy and straightforward. For more information on organic baby formulas check out our other blog post. 

When deciding on baby formula we also need to remember all babies are unique and all have different needs. What might work for some will not work for others. If a set of twins can be on two completely different formulas due to different conditions or dietary intolerances then any advice in choosing baby formula should always be verified and agreed upon with a registered health practitioner (your paediatrician, baby clinic, etc).

“Even though my breastfeeding journey with my son was hard work I decided to give it a go second time round with my daughter. This time things were better on the breastfeeding front. The milk supply seemed to have been higher by comparison but non-stop crying for hours, difficulty to settle down, followed by sleepless nights and days reduced my milk supply dramatically and resulted in a diagnosis of combination of a silent reflux & colic for my daughter. At that time my immediate thought was to default to an organic formula product my son was on but unfortunately due to my daughter’s condition we needed to try a formula product designed to assist with a reflux/colic. Three formula products later, her reaching 6 months and no longer needing Nexium and we finally had a happy baby and a less tired mama. I certainly couldn’t get this right without the assistance of both paediatrician and a baby clinic nurse.” - Kasia Bergh, MyMilkClub founder.

When your choice is formula feeding but your baby has been diagnosed with a condition such as: colic, reflux, diarrhoea, constipation or a dietary intolerance/allergy such as: lactose intolerance or cow’s milk protein allergy then your focus needs to be on speciality formulas under the supervision of your registered health practitioner.

In the case when you opt in for formula feeding and your baby has not been diagnosed with any of the above conditions or allergies your choices of different formula products are vast and the process of choosing the right one can be overwhelming.

What could be helpful here is to know the difference between standard and premium formula products on the market as this could further assist you with your elimination process.

All modern infant formula compositions are well researched and are created to meet your baby’s nutritional needs. They are manufactured under sterile conditions and created to duplicate breast milk by using a complex combination of proteins, sugars, fats and vitamins. 

Even the entry level standard baby formulas have to meet all the nutritional requirements, as dictated by the relevant bodies, such as CODEX (a collection of internationally adopted food standards).

They must contain a certain number of vitamins and minerals in certain quantities, and be made up of an acceptable blend of proteins, carbohydrates and fats in order to be labelled as an infant formula.

However, premium infant formulas contain additional ingredients over the ones mentioned above for increased nutritional benefits. These are prebiotics and probiotics for good gut health as well as Omega-3 fatty acids such as DHA (docosahexaenoic acid) and ARA (arachidonic acid) that are beneficial for baby’s eye and brain development and are essential fats present in breast milk. Premium formulations also contain antioxidants to keep baby’s cells healthy as well as nucleotides - building blocks of our DNA also found in human milk, with benefits linked to the immune system development.

So whether you offer your baby entry level formula product, premium formulation or an organic alternative, stay assured that each one of these options meet the required criteria and are an acceptable food for your baby if you decide on formula feeding versus breastfeeding.

Process of choosing the right formula - how most of us approach it?

When we asked moms in our community how they went about choosing their baby’s formula most of the answers were divided into two groups:

  1. Asked friends/family members/anti-natal class mom groups for advice based on their personal experiences/choices.

Or/And

  1. Consulted with their paediatrician, baby clinic, family planning clinic, dietician etc. The latter was more popular in the case where conditions, digestive issues and allergies were present.

Although it’s totally understandable that as humans we would always seek advice/recommendations from our trusted tribes first, let’s remember that all babies are different and their acceptance of baby formula products might differ from one baby to another, especially when digestive issues are concerned.

So chat to your tribes but always chat your potential choices through with your doctor that knows your baby’s history and your feeding journey thus far.

Even though we live in the time when most of the information is a click of a button away, surprisingly, internet research on baby formula feeding information available in South Africa was low on the popularity scale amongst our moms. It was actually met with a great deal of frustration instead as there is hardly any information available at all.

Why there is no information on formula feeding in the South African context available on the internet?

It is due to the legislation called R991 act, which essentially regulates how any foods for infants and young children under the age of three years are allowed to be marketed and sold. In doing so it prohibits promotional activities, including access to information, with regards to infant formulas. There are a number of reasons as to why, however the main one is government’s declaration to support breastfeeding, in line with World Health Organization’s (WHO) international promotion of breast is best. For more detailed information on this head to the local parenting blog BabyYumYum.

With everything in mind, our recommendation when researching the topic of baby formula feeding would be to turn to credible and reputable sources and preferably local to ensure the quality information within the South African context and in line with the regulations.

At MyMilkClub we are on a mission to source credible information and resources, share it with our community and simplify the topic of baby formula and formula feeding so parents can be more confident when making their decisions.

Please refer to the list of references at the end of this post to learn about our sources, that we not only relied on when writing this piece but also in our motherhood journeys of our own.

Baby formula ingredients spotlight

Baby formula products are formulated to duplicate breast milk using a complex of combination of proteins, sugars, fats and vitamins.

Proteins:

The standard (and default) source of protein in infant formula comes from cow’s milk.There are 2 main types of cow’s milk protein present in a cow’s-milk-based formula. These are whey proteins and casein proteins. 

According to  Bridget Young, PhD, a certified lactation counselor and an Assistant Professor of Pediatrics at the University of Rochester, in her summary:

  • Whey empties the stomach faster, and casein is more “reactive”.
  • The individual proteins that compose human breast milk casein and whey are not the same as the individual proteins that compose cow’s milk casein and whey.
  • Cow’s milk protein is ~20% whey and 80% casein while human milk is ~60% whey and 40% casein.
  • A baby formula that has additional whey added or is 100% whey is to more closely resemble breast milk (look for additional whey further down the ingredients list on the back of the formula tin)

The alternative source to any cow’s milk-based baby formula is a soy-based formula. The protein in these formulas will appear on the ingredients list (as the first or second ingredient) as “soy protein isolate”.

Another alternative to cow’s milk-based or soy based formula is a goat’s milk formula.

More on these two types sources of proteins later.

Sugars:

When you read the ingredients list on the back of baby formula tins you might be alerted when seeing corn syrup or sucrose as some of the ingredients. These sound a lot like types of sugars we try to avoid in other foods we eat.

However, in the case of baby formulas these ingredients are not considered sugars they are treated as carbohydrates - source of energy which babies need to grow. Babies can't digest complex carbohydrates like fiber, so the carbs in formula need to be simple and easily broken down.

The carbohydrate in breast milk is lactose (the same sugar that's found in cow's milk). Breastmilk is 100% lactose. Many formula manufacturers use lactose as a main carb source in their product to mimic the composition of breast milk and because it's easy to digest.

Selected formulas (standard and premium) on the South African market are 100% lactose based and others offer a combination of lactose, maltodextrin, fructose or dextrose.

However babies with lactose sensitivity or intolerance still need carbs in their formulations so in this case formulas can contain other simple carbs such as corn syrup/starch, sucrose or glucose syrup to maintain the correct carbohydrate level.

For instance, lactose-reduced or lactose-free formulas (including soy formula, formula designed for premature babies, and some "sensitive" formulas) use these types of carbs explains Dr Young.  She adds that these carbs may also be used in partially hydrolyzed formulas to mask the distinctive odour and flavour that comes from breaking down proteins.

So when shopping for formula Dr Young advises trying to find a formula that primarily uses lactose (it will be listed high on the ingredient list), unless you need a lactose-reduced formula. When possible, avoid a formula that uses sucrose, the sweetest simple carb, as the main carbohydrate, so your baby doesn't develop a high preference for very sweet flavours. Lactose is the least sweet carb in the group.

If your baby is already on a formula that does have sucrose and is doing well, leave it be, says Young. "If your baby is thriving, then you've found the perfect formula for him or her," she says. Swapping formulas can be hard on babies. And remember that breast milk is sweet too, so both breastfed and formula-fed babies are being exposed to sweet flavours from the start.

Fats:

Fats make up about 50% of baby’s nutritional intake and baby formulas have been formulated to mirror that. All formulas try to mimic the fatty acid composition of breast milk as close as possible.

As seen on the formula tins’ list of ingredients all formulas contain a combination of fats sourced from: palm olein oil, soy oil, coconut oil, sunflower oil and others (rapseed/canola, tocopherol or mortierella alpina: arachidonic acid (ARA)).

Most of the baby formula products on the South African market, but one, contain a palm oil. In recent years the use of palm oil in baby formula products has been somewhat controversial, due to environmental and sustainability issues linked to the palm trees vegetation, however most baby formula manufacturers on the South African market have got sustainability initiatives in place, including implementation of sustainably sourced palm oil.

In addition to that breastmilk contains a level of palmatic acid (over 20% of the total fatty acid content) so formulas with palmatic acid derived from the palm fruit are closer in composition to that of breastmilk.

An alternative to a palm oil is a coconut oil which is also derived from a palm tree, but a different species of palm tree to the one that the palm oil comes from. Coconut oil mainly contains medium-chain fatty acids and is very easily digested.

According to South African paediatric dietitian Kath Megaw: “All formulas adhere to strict guidelines and as far as fat goes, my preference is a combination of a variety of fats to cover all the fat subgroups out there. Medium-chain fats are very easy to digest and babies’ brains can utilise medium-chain fats such as coconut oil for instant energy.”

For more useful information on the use of palm oil in baby formulas please head to BabyYumYum.

 

Different types of baby formulas

Earlier on we talked about the difference between standard and premium formulas as well as organic formulations. Below we put a summary on the most common types of baby formula:

Cow’s milk based formula

Most formulas have cow’s milk as their main ingredient due to the right balance of protein, fat and carbohydrates however altered to make it safe and easy to digest (by heating the protein for instance). More lactose is also added to closely resemble breast milk's composition. Fat (butterfat) is removed and replaced with other oils and fats that are more easily digestible. These formulas have added iron as well.

Cow’s milk is not recommended for babies younger than a year as it doesn’t contain enough iron, vitamins A,C and D, is difficult to digest and is too high in protein and sodium.

Hydrolyzed formula

Cow’s milk based formula treated with enzymes in order to break down most of the cow’s milk proteins  into smaller proteins so they are easier to digest. Recommended for babies who have a high risk of developing allergies (due to family history). It can also be advised for babies that are fussy after eating which could indicate problems in digesting regular cow’s milk formula or have an allergy to milk protein.

Premature babies can also be prescribed with hydrolysed formulas when they have problems with absorbing nutrients.

There are partially hydrolyzed and extensively hydrolyzed formulas.

Partially hydrolyzed formulas take cow's milk proteins (whey, casein) and break them into smaller pieces. Some formulas have a whey and casein blend that is partially hydrolyzed, while others may have 100% whey protein that is extensively hydrolyzed. These formulas are NOT used for babies diagnosed with cow's milk allergy.

Specialised formula

Specialised formulations are designed for special medical purposes such as severe cow's milk protein allergies or for premature babies.

There are also formula products available on the market that are specifically designed to address conditions such as colic, reflux, constipation and diarrhea in babies.

Formula for premature babies

These formulations have more calories and specific nutrients.

Formula for constipated babies

More lactose than regular milk-based formula designed for babies with some constipation on milk-based formula.

Formula for babies with excessive acid reflux

Thickened formula for babies with confirmed reflux that interferes with growth.

Formula for diarrhea

Lactose free formulas that can also contain additional rice flour and banana and/or apple puree as well as increased electrolytes. Soy based formulas are also advised in the case of diarrhea.

Lactose-free formula

Formulations with milk containing no lactose. These should be used under the guidance of a dietician or a paediatrician after a confirmed diagnose of lactose intolerance. These formulations could also be used to treat diarrhea.

Formula for fussy babies

Less lactose than regular milk based formula for babies with some gas or who are very fussy on milk-based formulas.

Amino acid based formula

Recommended for babies with milk protein and soy allergies where protein is all in the from of amino acids.

 Soy based formula

Soya based milk formula made with a plant protein that is modified for easy digestion and supplemented with vitamins, minerals and nutrients. 

Suitable for babies with lactose intolerance, and milk protein allergies. Note however that use of soy milk or goat’s milk formula doesn’t not prevent the development of allergies in children.

Due to the fact that these formulas are even more different from breast or cow’s milk they are not recommended as the first formula choice unless parents favour vegetarian diet.

Goat milk based formula

Goat’s milk is thought to be naturally easier to digest due to the the type of casein it contains.

Furthermore, while the fat content of goat milk is similar to that of cow milk, the fat globules are up to 75% smaller, and this may make them easier to digest as well.

For more detailed information on goat milk based formulas please check out our other blog post.

Formula feeding information

For formula feeding information guidelines please check out our summarised version of baby’s milk journey (0-36+ months) that explains the difference between the three stages of baby formula, and shares information on cow’s milk and solids introduction. It also contains a sample feeding schedule based on age (0-12+ months).

Please treat both sources as a guideline only. When making your own choices regarding your baby’s milestones you should always consult with a registered health practitioner first.   

Remember to also always consult with a registered health practitioner before you consider the introduction of infant formula product supplementation or changing from one formula product to another.

Head to MyMilkClub store for more information on our curated selection of premium baby formulas, all available either as once-off purchase or AUTOMILK subscription

 

References:

  1. “Feeding Sense” by Meg Faure, Kath Megaw and Dr Simon Strachan https://www.megfaure.com/product/feeding-sense/
  2. “Baby Sense” by Meg Faure and Ann Richardson https://www.megfaure.com/books/baby-sense/
  3. “Weaning Sense” by Meg Faure and Kath Megaw https://www.megfaure.com/product/weaning-sense/
  4. “Formula or breastfeeding it’s your choice!” https://babyyumyum.co.za/formula-or-breastfeeding-its-your-choice/
  5. “ Is the use of palm oil in in baby formula controversial?https://babyyumyum.co.za/is-the-use-of-palm-olein-in-baby-formula-controversial/
  6. “What are nucleotides?” www.neocate.com
  7. “Is there sugar in baby formula?” https://www.parents.com/recipes/scoop-on-food/is-there-sugar-in-baby-formula/
  8. “Best baby Formula - Protein Source” https://babyformulaexpert.com/baby-formula-protein-source/

Disclaimer: This is not a sponsored post. MyMilkClub reserves the right to its opinions and fully supports the notion of promotion that breast is best in line with the World Health Organisation (WHO) infant feeding guidelines. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of an infant’s life, and continued breastfeeding with complementary foods for up to two years of age. Breast milk is the best food for infants. Good maternal nutrition is essential to prepare and maintain breastfeeding. If breastfeeding is not possible, an infant formula may be used according to the advice of registered health professionals. Preparation and storage of any infant formula should be performed as directed on the tin in order not to pose any health hazards.