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♂Choosing the Best Baby Formula
♂Health Information Advisory on Infant Formula
♂Exempt Infant Formulas Marketed in the United States By Manufacturer and Category
♂Formula Feeding FAQs: Getting Started
♂Formula Feeding FAQs: Preparation and Storage
♂Formula Feeding FAQs: How Much and How Often
♂Formula Feeding FAQs: Supplementing
♂Formula Feeding FAQs: Starting Solids and Milk
♂Formula Feeding FAQs: Some Common Concerns

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Choosing the Best Baby Formula
http://www.viewpoints.com/guides/Baby-Formula-Choosing-the-Best-Baby-Formula

Breast milk is the primary diet for infants during the first six months of life. The American Pediatric Association recommends that mothers breastfeed for as long as possible - even if it is only a few weeks - because of the various health benefits for mother and baby. Breast milk helps build a child's immunity and protects them from gastrointestinal problems and ear infections. Plus, it helps a mother and infant bond. Ultimately, however, using baby formula can become necessary depending on each family's circumstance.

You may opt to supplement breast milk with baby formula initially or simply wean your baby from breast milk entirely. Regardless, choosing a baby formula is a highly personal choice for each new mom. It is best to discuss the process with your baby's pediatrician before researching the types of formula to buy. Ask about essential nutrients that should be in the formula, what brands the pediatrician recommends and which types. In the end, however, you'll be choosing a baby formula that you're comfortable giving to your baby - and that your baby will eat!

Once you've determined with your doctor that your baby is ready for baby formula, get personal advice here from a real mom. Learn from her about the best brands, types and more.

1ㄝWHAT BABY FORMULA IS AVAILABLE?

Baby formula can come in a variety of forms (powder formula, concentrate and ready to feed formula). Each has their own unique pros and cons depending on the needs of the buyer.

♂Powdered baby formula: Contained in a canister, all you need to do is measure it out with a scoop, add water and shake. Powdered formula is probably the most common format and by far the least expensive. The biggest problem with powdered formula is properly measuring it to ensure the desired level of nutrients. Individual powder packets are available but of course you pay for this convenience.
♂Concentrated Baby Formula: In a pour-able format, all you have to do is add water and the bottle is ready to go. Although it is more costly, concentrated formula tends to be easier to mix.
♂Ready-to-Feed Baby Formula: As the most convenient way to feed baby, ready-to-feed is packaged in individual servings, generally either baby bottles or individual packets. You can be assured baby is receiving the right mix of nutrients, but you are also going to pay a lot more.

2ㄝWhat do all those "ingredient" terms mean?

When looking at a canister of baby formula there are many weird different terms you may have never heard of before. Here's a quick run down of some you will encounter:
♂Milk, soy or rice based formula: this refers to the primary ingredient the formula uses to derive the basic nutrients the same as with cow's milk, soy milk or rice milk.
♂Iron fortified formula (or with iron): Almost all formulas are fortified with iron. The APA recommends starting with a formula with iron, to reduce the risk of iron deficiency. Some babies though cannot tolerate the amount of iron in some formulas and will have a harder time filling their diapers. There are low-iron formulas available if needed.
♂DHA/ARA baby formula: Docosahexaenoic acid (DHA) and Arachidonic acid (ARA) are two very valuable fatty acids that most formula companies have begun adding to infant formulas. Although these are synthesized fatty acids found naturally in breast milk, it is theorized DHA and ARA are crucial for brain and eye development. Baby formulas fortified with these nutrients are usually more expensive than those without.
♂Organic baby formula: These days you can find pretty much everything with an organic alternative, including organic infant formula (or natural infant formula). So what does it mean for a formula to be considered organic? "Organic ingredients are produced without the use of growth hormones, antibiotics and other chemicals." (Similac)
♂Toddler formula: Designed for little ones 9 -24 months, toddler formulas provide extra nutrients during the time when baby is regularly eating solid foods but needs more nutrition than regular cow's milk can provide. Each of the major manufacturers as well as a few others have their own version. Toddler formula is slightly less expensive than baby formulas but much more costly than cow's milk. In general if your baby is eating a well balanced diet of solid foods a toddler formula is not necessary. NOTE: Toddler formulas should not be used by infants as they are more difficult to digest.

3ㄝWHAT ARE THE MAJOR BABY FORMULA BRANDS?

In the world of baby formula, there are three major manufacturers: Enfamil, Nestle Good Start, and Similac. Many store chains also have their generic version of infant formula such as Parent's Choice from Walmart. Your friends, family and doctor may have made recommendations but remember that, even though one baby absolutely loved Similac, another may only do well with Enfamil. Be prepared to experiment at first by purchasing smaller containers or using samples.

Every brand of baby formula must meet FDA requirements to ensure your baby receives the minimum nutrition. So, you can rest assured that your baby is receiving the nutrition he/she needs. Manufacturers then create their own recipes based on these guidelines. Of course each company is going to say their particular recipe is best, but even the American Academy of Pediatrics (AAP) does not recommend any one brand over another.

4ㄝWHAT'S THE DIFFERENCE AMONG THE MAJOR BRANDS?

The main difference between baby formulas is the protein used as a base for the formula as well as the predominant source of fat used.

♂Enfamil and Similac both use a mixture of whey proteins and Casein which is claimed to be the same composition as breast milk. The difference between these two is Similac does not use palm olein oil as the source of fat. Similac claims the absence of this oil assists with calcium absorption. The cost of these two formulas is fairly similar depending on which one is on sale at the time.
♂Nestle Good Start uses 100% whey proteins that are partially hydrolyzed which they call their "comfort proteins," which are supposed to be easier for baby to digest. So instead of being formulated like breast milk, it seems to behave like breast milk in the way it digests. This is a great baby formula for gassy babies or those with acid reflux.
♂As for generic/store brands, you will have to do some label reading to determine exactly what is being included. Examples of store brands include Parent's choice from Walmart, Target brand and Member's Mark from Sam's Club.

5ㄝBEST BABY FORMULAS: PARENTS SPEAK OUT

First things first... it's best to consult with your pediatrician for his/her recommendation on which formula is best for your baby. If your baby has specific needs your doctor will recommend a particular formula designed for that need.

If there is no recommendation from your doctor, and your child does not have special needs, you are lucky! The options are endless.... pick any of the three major brands and start with some DHA/ARA formula. It is speculated that these two ingredients help in brain and eye development. A one week supply will tend to cost around $25.

∴Willing to pay for quality?

A highly recommended infant formula is Nestle. Running a touch more expensive than the competition, Nestle offers the only formula to add a nutrient called BIFIDUS BL, which helps support baby's immune system.

∴Does your baby have special needs?

Both Enfamil and Similac have a wide variety of infant formulas specifically designed for little ones with digestion concerns. Several store brand formulas are also now manufacturing more special formulas as the needs are rising. There are also special formulas designed for infants with special medical conditions (such as premature babies or those needing extra supplement). Your pediatrician will recommend which one is best for each specific condition. Some of the choices available for common feeding problems include:

♂Gentle Formula - made for infants with fussiness or gas, the Gentle formulas have a lower amount of lactose as well as, broken down proteins to make it easier to digest.
♂Rice Formula - Got a frequent spitter-upper? Rice formulas are designed with a rice starch which is proven to reduce spit-up.
♂Hypoallergenic Formula - Some babies have sensitivities to both milk and soy proteins. To reduce allergic reactions these formulas are lactose free and have proteins that have been extensively broken down.
♂Soy Formula - Got Soy? Some babies cannot tolerate milk proteins. This is the time to look at a soy based formula. There are of course milk and lactose free formulas.

∴Going Green? What is your best bet in organic baby formula?

Organic baby formula is usually available in a milk based and soy based formula. Some of the common labels you will see include Baby's Only, Vermont Organics, Earth's Best and Similac. Earth&s Best, Vermont Organics and all store brand organic formulas are manufactured by the same company. For a comparison of the different organic formulas click here. Two of the highest rated organic baby formulas are:

♂Baby's Only organic formula: One of the top rated Organic Infant Formulas, Baby's Only derives uses 100% rice starch as the primary source of carbohydrate, which means there is only naturally occurring lactose in the milk based formula. Baby's Only formula is marketed as a toddler formula since the company believes infants should be breastfed until 12 months, but it contains all the nutrition required by an infant. Although DHA and ARA ingredients are not included in the formula, Baby's Only does produce a supplement for those who want these added nutrients.
♂Similac organic: As a leading manufacturer of baby formula, Similac produces an organic formula comparable to Baby's Only Organic. Similac Organic does include the valuable DHA/ARA ingredients that Baby's Only does not.

∴Are you on a tight budget?

Making the decision to exclusively formula feed is going to stretch the already tight budgets. Although there are some programs available to assist with purchasing baby formula, many budget conscious families do not qualify. There are a few things you can do to minimize the costs.

♂The competition is fierce between baby formula makers. Each one wants you to choose their brand over the competition. With their own version of a "baby club" these companies regularly provide free samples and product coupons/checks. Take advantage of these offers to help you choose which formula your baby prefers. Most hospitals give free samples to new moms as well.

♂If you are purchasing your baby formula from a grocery store, also purchase your diapers there. If the store that has check-out coupons, you will generally receive valuable formula coupons for the purchase of smaller size diapers.

♂Search for deals online as well as in stores. Using a formula coupon or check in coordination with a good sale can save lots. Also, you can often find good deals on baby formula on either amazon.com or ebay.com. Just remember to allow for shipping costs.

♂Once you have found the right formula, purchase larger containers. The higher the quantity, the better price per ounce you will pay. On this same note, take advantage of warehouse memberships if you can. Many people have one these days. Find a friend who would be willing to taken you to stock up (this is great for diapers as well.)

♂Consider store brand baby formulas. Remembering that all infant formulas sold in the U.S. must meet minimum requirements, a store brand formula can save over $5 per can. Compare the ingredients listed on the can and if they are similar enough for you then give it a try.

Good luck in your new adventure! Be comfortable with the infant formula you choose and do not hesitate to ask your pediatrician any questions you may have about bottle feeding your baby. That is what they are there for.

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Health Information Advisory on Infant Formula

In response to reports of contaminated milk-based infant formula manufactured in China, the Food and Drug Administration (FDA) issued a Health Information Advisory on September 12, 2008.

This is to assure the American public that there is no known threat of contamination in infant formula manufactured by companies that have met the requirements to sell infant formula in the United States.

1ㄝManufactured in China

It has been reported that a number of infants in China who have consumed Chinese manufactured infant formula are suffering from kidney stones, a condition which is rare in infants.

The Chinese manufactured infant formula may be contaminated with melamine. Melamine artificially increases the protein profile of milk and can causes kidney diseases, such as those seen in these Chinese infants.

Although no Chinese manufacturers of infant formula have fulfilled the requirements to sell infant formula in the United States, FDA officials are investigating whether or not infant formula manufactured in China is being sold in specialty markets which serve the Asian community.

FDA is asking state officials to work with the agency to remove Chinese infant formula found on store shelves, and to warn members of the Asian community to avoid using Chinese manufactured infant formula.

2ㄝAdvice to Caregivers
♂Don't feed infant formula manufactured in China to infants.
♂Use an appropriate infant formula manufactured in the United States as mentioned below.
♂Contact your health care professional if you have questions regarding the infant's health or if you note changes in the infant's health status.

3ㄝManufacturers That Meet FDA Requirements

FDA began investigating the reports of contamination immediately and received information from the companies who manufacture infant formula for the American market that they are not importing infant formula or source materials from China.

The following manufacturers have met the necessary FDA requirements for marketing milk-based infant formulas in the United States:
♂Abbott Nutritionals
♂Mead Johnson Nutritionals
♂Nestle USA
♂PBM Nutritionals
♂Solus Products LLC.

Also, one manufacturer, SHS/Nutricia, Liverpool, England, markets an amino acid based exempt infant formula that does not contain any milk-derived ingredients.

FDA requires that all infant formula manufacturers register with the agency and adhere to specific labeling and nutritional requirements. All properly registered manufacturers marketing infant formula in the United States undergo an annual inspection of their production facilities.

This article appears on FDA's Consumer Update page, which features the latest on all FDA-regulated products.

Updated: October 1, 2008

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Exempt Infant Formulas Marketed in the United States By Manufacturer and Category

An exempt infant formula is an infant formula intended for commercial or charitable distribution that is represented and labeled for use by infants who have inborn errors of metabolism or low birth weight, or who otherwise have unusual medical or dietary problems (21 CFR 107.3). Prior to any company or person manufacturing and marketing a new exempt infant formula or any infant formula, certain practices, procedures and processes must be followed (Section 412 of the Federal Food, Drug, and Cosmetic Act). For exempt infant formulas, there are specific terms and conditions that must also be met (21 CFR 107.50). The following list provides all of the products classified as exempt infant formulas that FDA believes are currently available (to date) on the U.S. retail market. The products are grouped by the company that manufactures and/or distributes them as well as grouped by type of product (if applicable).

This list is provided as a service to anyone using FDA's website and does not represent FDA endorsement of these companies or their products. FDA cannot ensure that the information on this list is the most current. As the agency becomes aware of newer information, the list will be periodically updated.

▽Abbott Nutrition▼

Metabolic Formulas---
♂Cyclinex-1
♂Glutarex-1
♂Hominex-1
♂I-Valex-1
♂Ketonex-1
♂Phenex-1
♂Propimex-1
♂Tyrex-1

Formulas for Premature Infants---
1. Similac Special Care 20 Cal w/Iron
2. Similac Special Care 24 Cal w/Iron
3. Similac Special Care 24 Cal w/Iron
4. Similac Special Care 30 Cal w/Iron
5. Similac Expert Care NeoSure

Protein Hydrolysate Formulas---
1. Similac Expert Care Alimentum

Amino Acid-Based Formula---
1. EleCare (to be discontinued in the US)
2. EleCare with DHA and ARA

Miscellaneous---
1. Calcilo XD
2. Similac Expert Care for Diarrhea
3. Pro-Phree
4. ProViMin
5. Ross No Added Carbohydrate Soy Formula w/Iron
6. Similac Human Milk Fortifier
7. Similac PM 60/40

▽Mead Johnson Nutrition▼

Metabolic Formulas---
♂Phenyl Free 1
♂BCAD 1
♂GA
♂HCY 1
♂LMD
♂OA 1
♂TYROS 1
♂WND 1

Formulas for Premature Infants---
1. Enfamil Premature LIPIL 20
2. Enfamil Premature LIPIL 20 w/Iron
3. Enfamil Premature LIPIL 24
4. Enfamil Premature LIPIL 24 w/Iron
5. Enfamil EnfaCare LIPIL
6. Enfamil Premature LIPIL 24 Cal High Protein

Protein Hydrolysate Formulas---
1. Nutramigen LIPIL
2. Pregestimil LIPIL 20
3. Pregestimil LIPIL 24
4. Nutramigen LIPIL Enflora with LGG

Amino Acid-Based Formula---
1. Nutramigen AA LIPIL

Miscellaneous---
1. Product 3232A
2. PFD 1
3. Enfamil Acidified Liquid Human Milk Fortifier
4. Enfaport LIPIL with MCT Oil

▽Nestle Infant Nutrition▼

Formulas for Premature Infants---
1. Gerber Good Start Premature

PBM Nutritionals
Formulas for Premature Infants〞
1. 22 cal/oz milk-based infant formula with DHA and ARA for Conditions such as Prematurity (sold under private labels)

Prolacta Biosciences, Inc.
Miscellaneous〞
1. Prolact Plus Human Milk Fortifiers (+4, +6, +8, and +10)

▽SHS International Limited*▼

Metabolic Formulas---
♂MSUD Analog
♂XLeu Analog
♂XLys, Trp Analog
♂XMet Analog
♂XMTVI Analog
♂Periflex Infant (formerly known as XPhe Analog)
♂X Phe, XTyr Analog
♂XPTM Analog
♂XMet, XCys Analog

Amino Acid-Based Formula---
♂Neocate Infant
♂Neocate Infant w/DHA and ARA

*Nutricia North America is listed on the product labels. Nutricia North America is the distribution company and "brand" name for the products manufactured by SHS International in the United Kingdom.

7/11

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Formula Feeding FAQs: Getting Started

The major health organizations 〞 including the American Academy of Pediatrics (AAP), American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) 〞 agree that breast milk is the ideal form of nutrition for babies (especially during the first 6 months). However, only you can decide what's best for you and your baby. And commercially prepared formulas are designed and strictly regulated to provide the nutrients your baby needs.

Whether you've decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you're bound to have questions. Here are answers to some common questions about formula feeding.

1ㄝWhat supplies do I need?

Shopping for formula-feeding supplies can be downright intimidating, especially at first. From formula to bottles, from nipples to sterilizers, the choices can seem endless for new parents.

But with most of the supplies you'll need, it's probably a good idea to hold off buying 〞 or registering for 〞 too much of any one type of product, whether it's formula, bottles, or nipples. After all, you may end up having to return them when you find that your baby doesn't like what you've chosen. Your little one may actually prefer something completely different.

2ㄝWhat type of formula should I use?

Many different formulas (at a wide variety of prices) are available these days, which can make the process of choosing one a little overwhelming at first. Of course, which brand you use is up to you, your baby, and your budget. All your friends may have told you that Brand XYZ is the way to go, but your baby might think differently.

Infant formula comes in three basic forms:
♂Powders that require mixing with water and are the least expensive.
♂Concentrates, which are liquids that require diluting with water.
♂Ready-to-use (or ready-to-feed) liquids that can be poured right into bottles. These are the most expensive but are convenient if you're traveling or can't get to a sterile water supply quickly.

And within those choices are even more choices. The many kinds of formula on the market include:
♂Cow's-milk-based formulas, which make up the vast majority of formulas. Most milk-based formulas have added iron, which the AAP recommends.
♂Soy-based formulas (for babies who may be lactose intolerant or allergic to cow's milk), which sometimes have added iron. However, some babies who are allergic to cow's milk also are allergic to the protein in soy formulas.
♂Hypoallergenic formulas for babies who can't tolerate the basic formulas, like those with allergies to milk or soy proteins. The proteins in these hypoallergenic formulas are broken down to their basic components and so are easier to digest.
♂Specialized formulas designed for premature, low birth-weight babies.

Some formulas can be much pricier than others. All formulas manufactured in the United States have to meet strict nutritional standards from the U.S. Food and Drug Administration (FDA), so just because a formula is name brand (versus generic) doesn't necessarily mean that it's the best for your baby.

To help you decide which one to pick when you're in that jam-packed formula aisle in the store, ask your doctor about which brands might be best for your baby. You also can talk to other parents of infants about what they use and why.

Whatever kind you choose, make sure to check the expiration date on all cans and bottles of formula, and don't use formula from leaky, dented, or otherwise damaged containers.

3ㄝWhat about formula with DHA or ARA?

DHA (docosahexaenoic acid) and ARA (arachidonic acid) are ingredients that can be found in some, but not all, formulas.

DHA and ARA are polyunsaturated fatty acids (considered the "good" kinds of fat) that may be linked to brain and nerve development and can be found naturally in fish oils and eggs. The fatty acids are also found in breast milk. By putting DHA and ARA in infant formulas, the manufacturers are attempting to make their formulas as close to breast milk as possible.

But is it beneficial to buy an infant formula with these ingredients? The jury still seems to be out on that. Some studies have indicated that formulas supplemented with DHA and ARA benefit visual and cognitive development. But others haven't shown any significant improvement with DHA and ARA formulas.

4ㄝFormula can be pricey. Any way to cut costs?

Just as you may do already for your groceries and other baby supplies, shop around for the best deals on the formula you've chosen:
♂After your baby is born, ask the nursing staff in the hospital if there are any coupons or freebies available for you to take home.
♂Take advantage of all of the free samples and coupons you receive in the mail the first few months after your delivery. Many times, new moms are placed on mailing lists for everything baby-related, from children's book clubs to formula companies.
♂Clip coupons. You may even want to save some for different kinds of formula, in case you end up changing your baby's formula for some reason.
♂See if your child's daycare has a coupon exchange program in which parents bring in their coupons and other moms and dads take what they need.
♂Sign up for online coupon clubs that allow you to print and save coupons for only the things you indicate you need.
♂Sign up for formula companies' clubs and special programs (through the mail or online) that may offer discounts, coupons, and/or free formula and other products.
♂Compare prices on formula at your local grocery stores. Some stores also have special clubs that allow you to regularly save on certain products.
♂Check for specials at your local grocery stores and/or baby center.
♂See if your local wholesale/bulk items store offers your baby's formula for cheaper than local grocery stores. But don't automatically expect it to be less expensive in the long run just because it comes in a bigger container. Whether you're buying in bulk 〞 or in bigger sizes 〞 be sure to do the math on how much you're spending per ounce. Sometimes, it may seem like a deal when it really isn't.
♂At well-child or sick-child visits, ask your doctor if any samples or coupons are available. Offices often receive these from the formula companies.

5ㄝWhat kind of bottle should I use?

Bottles come in different shapes and sizes, can be made of glass or plastic, and may be reusable or have disposable liners inside. Some babies do better with certain shapes or bottles with liners on the inside. You may need to try a few different brands before you find the one that works best for you and your baby.

It's important to note that some plastic bottles are labeled "BPA-free"〞 meaning that they do not contain the chemical bisphenol A, which is found in some plastics and may effect development in children. Glass bottles are free of BPA and can last for a long time, but can crack and chip, so they need to be checked frequently to avoid harm to your baby.

6ㄝWhat kind of nipple should I use?

Walk down the nipple aisle in your local baby center and it's easy to be completely overwhelmed. For starters, nipples come in silicone (clear) or latex (brown). But the options don't end there.

The many different varieties include orthodontic nipples, rounded nipples, wide-based nipples, and flat-top nipples, just to name a few. And some are advertised as being closer to the natural shape of a mother's breast. But which kind is best really depends on your baby and what he or she seems to prefer. After all, every baby is different.

Nipples also often come in different numbers, "stages," or "flow rates" to reflect the size of the nipple's hole, which affects the flow (i.e., slow, medium, or fast) of formula or breast milk. For example, fast flows may cause younger babies to gag or may simply give them more than they can handle, whereas slower flows may be frustrating to some babies and may cause them to suck more vigorously and gulp too much air.

But whether these different flows are necessary depends on each baby. Your little one may seem to prefer variety or may be content throughout infancy to use the same kind and size of nipple. If your baby seems fussy or frustrated with the nipple, you can certainly try a different kind (like one with a larger hole) to see if it makes any difference.

7ㄝHow often should nipples be replaced?

That depends on how the nipples you're using hold up to cleaning, sterilizing, and everyday use. Be sure to check them regularly for signs of wear and replace them often. Also, as your baby grows, he or she might prefer nipples that come in different sizes and flows (the holes get bigger as babies get older and are ready to handle faster flows).

8ㄝWhat are follow-up formulas?

For babies from 4-12 months old, some manufacturers offer follow-up formulas with more nutrients. While every child's nutritional needs are different, most do not need to change to follow-up formulas. Before starting your baby on a follow-up formula 〞 or any formula different from the one you've been using 〞 talk to your doctor about whether this is right for your little one.

Reviewed by: Larissa Hirsch, MD
Date reviewed: March 2009

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Formula Feeding FAQs: Preparation and Storage

The major health organizations 〞 including the American Academy of Pediatrics (AAP), American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) 〞 agree that breast milk is the ideal form of nutrition for babies (especially during the first 6 months). However, only you can decide what's best for you and your baby. And commercially prepared formulas are designed and strictly regulated to provide the nutrients your baby needs.

Whether you've decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you're bound to have questions. Here are answers to some common questions about formula feeding.

1ㄝDo I need to sterilize my baby's bottles?

Yes. Before the first use, you'll need to sterilize nipples and bottles in a rolling boil for 5 minutes. You can also sterilize them with a store-bought countertop or microwaveable sterilizer, but boiling works just as well and costs nothing. After that, you'll need to wash bottles and nipples in hot, soapy water (or run them through the dishwasher) after every use. They can transmit bacteria if not cleaned properly.

2ㄝHow do I prepare my baby's bottles?

How you actually prepare the bottles depends on the type of formula you buy. Follow the instructions on the label exactly, using the precise amounts of water and formula specified. Both using too much water or too much formula can cause problems for your baby.

For babies up to 6 months of age, it's recommended that you boil the water that you add to concentrated or powdered formula. Though municipal water is typically fine, there is the possibility that the water supply can become contaminated. The U.S. Food and Drug Administration (FDA) says you should bring water to a very bubbly boil, keep it boiling for 1 to 2 minutes, then let it cool. (When using tap water, run it on cold for 2 minutes to help flush out any lead or other impurities.)

There's also bottled water available for infant use. Some of these products have added fluoride, so check with your doctor before using them. And unless the bottle's label indicates that it's sterile, you'll need to boil it as well.

3ㄝHow do I warm my baby's bottles?

Some babies may actually prefer cold or room-temperature bottles to warm, especially if you start serving them that way from the get-go (which can make things easier for you in the long run). But if your baby does prefer a warm bottle, remember that the microwave can create dangerous "hot spots" in bottles, so you should never microwave formula.

Instead, you can:
♂Run the bottle under very warm or hot water for a few minutes.
♂Put your baby's bottles in a pan of hot water. Just be sure to remove the pan from the heat source before placing the bottle in it.
♂Use bottle warmers that either sit on your countertop at home or plug into your car's lighter.

Whichever way you choose to heat your baby's bottles, be sure to shake the bottle vigorously. Then test the temperature of the formula by squirting a drop or two on the inside or your wrist before feeding your baby. It should be lukewarm (barely warm) not hot.

4ㄝHow long can mixed formula keep in the fridge?

You should always refrigerate any bottles you fill for later feedings to prevent bacteria from growing, as well as any open containers of ready-to-feed or concentrate formula. Throw away any mixed formula after 24 hours and any open ready-to-feed or concentrate formula after 48 hours.

5ㄝHow long can a bottle keep at room temperature?

Discard any prepared or ready-to-feed formula that's been sitting out after 1 hour.

6ㄝIf formula is left over, can I offer it again?

No, throw away any leftover formula. There's a chance bacteria may have formed since the last feeding, which could make your baby sick.

Reviewed by: Larissa Hirsch, MD
Date reviewed: March 2009

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Formula Feeding FAQs: How Much and How Often

The major health organizations 〞 including the American Academy of Pediatrics (AAP), American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) 〞 agree that breast milk is the ideal form of nutrition for babies (especially during the first 6 months). However, it's your choice to decide what's best for you and your baby. And commercially prepared formulas are designed and strictly regulated to provide the nutrients your baby needs.

Whether you've decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you're bound to have questions. Here are answers to some common inquiries about formula feeding.

1ㄝHow can I tell when my baby is hungry?

It's generally recommended that babies be fed whenever they seem hungry, which is called demand feeding (or feeding on demand).

And if your baby is very young, or having problems gaining weight, you shouldn*t go too long without feeding, even if it means waking your baby. In this case, talk to your doctor about how often your baby should be fed.

Despite what some new parents might think, crying is a late sign of hunger. You should try to feed before your baby gets so hungry that he or she gets really upset and becomes difficult to calm down. It's also important, however, to realize that every time your baby cries it is not necessarily because of hunger. Sometimes babies just need to be cuddled or changed. Or they could be overstimulated, bored, or too hot or too cold.

One way to tell if your baby is, indeed, ready to eat is to check the clock. If your baby is crying only an hour after a good feeding, there may be something else causing the distress.

Signs that babies are hungry include:
♂moving their heads from side to side
♂opening their mouths
♂sticking out their tongues
♂placing their hands, fingers, and fists to their mouths
♂puckering their lips as if to suck
♂nuzzling again their mothers' breasts
♂showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

Watch your little one's cues so that you're feeding when your baby is showing signs of hunger, which is usually every 2-3 hours during the newborn period. As your baby gets a little bigger and can take bigger feedings, this stretches out to every 3-4 hours.

2ㄝHow often should I make my baby's bottles?

Some parents opt to make a bottle just before each feeding, but many others choose to pre-make and refrigerate enough to use for the day. If you know your baby eats every 3-4 hours, for instance, you can make six to eight bottles to last you all day.

Mix your baby's formula in 2- or 3-ounce (60- or 90-milliliter) servings for the first few weeks and gradually increase the amount as you become familiar with your baby's eating patterns and appetite. Remember to refrigerate it immediately after mixing.

If your baby is staying with a caregiver for a long period of time, you may want to prepare just one or two bottles and leave instructions and supplies (bottles, nipples, formula, and water, if necessary) so the caregiver can prepare bottles as needed and not waste any formula. After all, you'll need to throw away any mixed formula after 24 hours.

3ㄝIs my baby eating enough?

Babies grow at different rates, and at times you may wonder whether your baby is getting enough nutrients to develop properly. Here's a general look at how much your baby may be eating at different stages:
♂On average, a newborn consumes about 1.5-3 ounces (45-90 milliliters) every 2-3 hours. This amount increases as your baby grows and is able to take more at each feeding.
♂At about 2 months, your baby may be taking 4-5 ounces (120-150 milliliters) at each feeding and the feedings may be every 3-4 hours.
♂At 4 months, your baby may be taking 4-6 ounces (120-180 milliliters), depending on the frequency of feedings and his or her size.
♂By 6 months, your baby's formula intake can be between 24-32 ounces (720-950 milliliters). This also depends on whether you've introduced any baby food.

Your newborn's diapers are another good indicator of when your baby is getting plenty to eat. You'll probably be changing at least six wet and four dirty (soiled or "poopy") diapers each day at first.

Newborns' stools (or poop) are thick and tarry in the beginning and then become more yellow or green as they get older. Formula-fed babies often have firmer, less seedy stools than breast-fed babies.

Wet diapers should have clear or very pale urine. If you see orange crystals in a wet diaper, contact your baby's doctor 〞 these can be a sign of inadequate fluid intake or dehydration.

Other possible signs of underfeeding include:
♂not gaining enough weight
♂seeming unsatisfied, even after a complete feeding

To help determine whether your baby is eating enough, follow the schedule of regular well-child checkups so that your little one can be weighed and measured. If you're concerned or notice any signs that your baby isn't getting enough nutrients, call your doctor.

4ㄝWhy does my baby seem hungrier than usual?

As babies gain weight, they should begin to eat more at each feeding and go longer between feedings. Still, there may be times when your little one seems hungrier than usual.

Your baby may be going through a period of rapid growth (called a growth spurt). These can happen at any time, but in the early months growth spurts often occur at around:
♂7-14 days old
♂between 3-6 weeks
♂4 months
♂6 months

During these times and whenever your baby seems especially hungry, follow his or her hunger cues and continue to feed on demand, increasing the amount of formula you give as needed.

Reviewed by: Larissa Hirsch, MD
Date reviewed: March 2009

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Formula Feeding FAQs: Supplementing

The major health organizations - including the American Academy of Pediatrics (AAP), American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) - agree that breast milk is the ideal form of nutrition for babies (especially during the first 6 months). However, it's every couple's choice to decide what's best for them and their babies. And commercially prepared formulas are designed and strictly regulated to provide the nutrients your baby needs.

Whether you've decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you're bound to have questions. Here are answers to some common inquiries about formula feeding.

1ㄝI'm breastfeeding but also want to start giving my baby formula. Is this OK?

The AAP recommends exclusively breastfeeding (that is, giving the baby no other food, beverages, or formula) for the first 6 months. And many of the health benefits of breastfeeding come during the first 2 months from protective antibodies in breast milk that can help keep babies healthy.

Unless your child's doctor recommends it, avoid giving your baby formula and breast milk (this is called supplementing) at least until your milk supply has had a chance to develop and both you and your baby are used to the concept of breastfeeding. Most lactation professionals recommend that parents wait at least 1 month before offering pacifiers or artificial nipples of any kind to avoid nipple confusion. Early supplementing also can lead to a reduction in your milk supply.

If you are having a hard time pumping or need to go back to work, supplementing breast milk with formula may be the only option if you still want to continue breastfeeding. After all, some breast milk is better than none at all.

It's important to remember that your baby's health and happiness is, in large part, determined by what works for you as a family and is not solely based on recommendations. So if you need to supplement or even go to 100% formula, your baby will be fine and healthy, especially if it creates less stress for you.

2ㄝIf I want to begin giving my breastfed baby formula how should I start?

Depending on how much formula you'd like to give your baby (whether it's one bottle a day, one bottle a week, or several bottles throughout the day), you can begin by eliminating the desired amount of breastfeeding or pumping sessions. Of course, as you eliminate feedings, your milk supply will decrease and your body will begin to adapt to produce enough milk to accommodate your new feeding schedule. To reduce uncomfortable engorgement from skipping regular feedings, you may want to gradually decrease feedings over time.

Starting your breastfed baby on formula can cause some constipation or hardening of the stools (or poop), but continuing to nurse and adding some prune juice to the formula can help keep your baby's stools soft. Mixing some of your pumped breast milk with formula also can help your baby to better digest the formula and get used to the new taste, but this isn't necessary. You can still nurse from the breast and introduce the bottle as you need to. Be sure to talk your child's doctor, though, if your baby is having trouble pooping.

3ㄝShould I give my baby the bottle at first or should I have someone else do it?

You should have someone else give your little one the bottle at first. Why? Because babies can smell their mothers and they're used to receiving breast milk from mom, not a bottle. So try to have someone else - such as a caregiver or partner - give a breastfed baby the first bottle.

Also consider either being out of the house or out of sight when your baby takes that first bottle, since your little one will wonder why you're not the doing the feeding as usual. Depending on how your baby takes to the bottle, this arrangement may be necessary until he or she gets used to formula feeding. If your little one has a hard time adjusting to this new form of feeding, just be patient and keep trying.

Reviewed by: Larissa Hirsch, MD
Date reviewed: March 2009

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Formula Feeding FAQs: Starting Solids and Milk

The major health organizations 〞 including the American Academy of Pediatrics (AAP), American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) 〞 agree that breast milk is the ideal form of nutrition for babies (especially during the first 6 months). However, it's your choice to decide what's best for you and your baby. And commercially prepared formulas are designed and strictly regulated to provide the nutrients your baby needs.

Whether you've decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you're bound to have questions. Here are answers to some common inquiries about formula feeding.

1ㄝWhen should I introduce solid foods?

Although in the past many parents started giving their babies solids early on, the AAP now recommends waiting until babies are 4-6 months old. Why? Because feeding solids earlier than this can increase the chances of your baby developing food allergies.

Water, juice, and other foods are usually unnecessary during a baby's first 6 months. Breast milk or formula provides everything babies need nutritionally until they start eating solid foods.

Watch for signs of solid-food readiness, such as your baby having good head control, losing the tongue-thrusting reflex and seeming interested in other people's food. Always start with baby cereal (rice cereal is usually the best one to introduce first) on a spoon before advancing to fruits and vegetables. But do not add cereal to your baby's bottle unless your doctor instructs you to 〞 it can be a choking hazard and can make babies overweight.

Also, fruit juices should not be given to babies younger than 6 months, unless the doctor tells you to do so. Even when your baby is older, keep fruit juices to a minimum (no more than 4-6 ounces, or 120-180 milliliters, per day). Offer it in a cup, not a bottle. Too much juice can fill your baby up (leaving little room for more nutritious foods), promote obesity, and put your baby at an increased risk for cavities when teeth start coming in.

When you do give your baby juice, make sure it's pasteurized and dilute it with water. And remember to never put your baby to bed with a bottle or capped cup. Doing so can cause choking and increase your baby's risk for cavities from the sugar in the juice, formula, or breast milk.

2ㄝWhen can I start giving my baby cow's milk?

Infants under 1 year still need the nutrients in breast milk or formula. But at 1 year old, you can begin offering your little one whole milk. Why not skim or 2%? Because babies need the fat in whole milk for normal growth and brain development during the busy early toddler period.

You can transition your baby from formula to whole milk by beginning to replace bottles of formula with bottles 〞 or sippy cups 〞 of milk. By 1 year old, your baby should be eating a variety of other foods and only 2-3 cups (480-720 milliliters) of milk per day.

If your baby was put on a soy or hypoallergenic formula for a milk allergy, talk to the doctor before introducing milk.

Reviewed by: Larissa Hirsch, MD
Date reviewed: March 2009

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Formula Feeding FAQs: Some Common Concerns

The major health organizations 〞 including the American Academy of Pediatrics (AAP), American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) 〞 agree that breast milk is the ideal form of nutrition for babies (especially during the first 6 months). However, only you can decide what's best for you and your baby. And commercially prepared formulas are designed and strictly regulated to provide the nutrients your baby needs.

Whether you've decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you're bound to have questions. Here are answers to some common inquiries about formula feeding.

1ㄝIs it OK to prop a bottle in my baby's mouth?

No. You shouldn't leave your baby unattended or feeding from a "propped" bottle. Propping a bottle is a choking hazard and can also lead to ear infections and baby bottle tooth decay, a serious dental condition that results from formula (as well as breast milk or juice) pooling in your baby's mouth. Always hold your baby during feedings.

2ㄝIt is OK to let my baby sleep with a bottle?

No. You should never put your baby to bed with a bottle. Like propping a bottle, it can cause choking, ear infections, and tooth decay.
How will I know if my baby has an allergy?

Some babies are allergic to the protein in cow's milk formula. Symptoms of an allergic reaction may include:
♂vomiting
♂diarrhea
♂abdominal pain
♂rash
♂even some blood in the baby's stools

Report any of these symptoms to your baby's doctor, and follow his or her advice on switching to a special hypoallergenic formula. But even if the doctor suspects an allergy, don't spend too much time worrying that your child might be allergic forever. Kids often outgrow milk protein allergies within a few years.

3ㄝIs soy formula safe for my baby?

Most doctors usually recommend giving babies cow's milk formula unless there seems to be an allergy or intolerance, in which case the doctor may recommend soy or hypoallergenic formula. Soy formula 〞 with added iron 〞 contains the nutrients your baby needs.

Some parents may worry after hearing or reading about certain soy concerns, particularly about phytoestrogens (hormone-like chemicals from plants) that are found in soy formulas. These concerns need to be studied further, but so far research has not found definite evidence that soy formulas negatively effect a child's development or reproductive system.

Soy formula should be used under the direction of your doctor, but it can be an alternative to cow's milk formula for full-term infants. However, soy formulas are not recommended for premature infants.

4ㄝDo I need to give my formula-fed baby vitamins?

No. Commercial infant formulas with iron are manufactured to contain all the nutrients your baby needs.

5ㄝDoes my baby need fluoride supplements?

Infants 〞whether breastfed or formula-fed 〞 do not need fluoride supplements during the first 6 months. From 6 months to 3 years, babies require fluoride supplements only if the water supply is severely deficient in fluoride. Ask your doctor about what your little one needs.

6ㄝMy baby is really fussy. How can I help?

Your baby's fussiness may or may not have anything to do with gas or the formula, nipple, or bottle you use. Some babies are simply colicky (continuously crying for long periods of time), especially during the first 2 to 3 months.

If your baby does seem to be gassy or colicky, here are some things that may help ease the gas pains and comfort your little one:
♂Walk with your baby or sit in a rocking chair, trying various positions.
♂Try burping your baby more often during feedings.
♂Place your baby belly-down across your lap and rub his or her back.
♂Put a warm towel or warm water bottle on your baby's belly, checking first to make sure it's not too hot.
♂Hold your baby upright.
♂Put your baby in a swing 〞 the motion may have a soothing effect.
♂Put your baby in an infant car seat in the back of the car and go for a ride. The vibration and movement of the car often calm a baby.
♂Try playing music 〞 some babies respond to sound as well as movement.
♂Try turning on the dishwasher, clothing dryer, or a white noise machine. The continuous gentle noise may sooth a crying baby.

Sometimes, fussiness and gas may be a sign of milk allergy or lactose intolerance. But be sure to talk to your doctor first before switching your baby's formula. Let the doctor know how your baby is acting so that he or she can rule out any other possible causes.

7ㄝIs it normal for my baby to spit up after feedings?

Sometimes, babies spit up when they:
♂have eaten too much
♂burp (the notorious "wet burp")
♂drool
♂cough or cry

Many infants will spit up a little after eating or during burping because their digestive tracts are immature. That's perfectly normal. But spitting up isn't the same as vomiting all or most of a feeding.

If you're concerned or your baby is vomiting (that is, forcefully vomiting much of a feeding) more than once a day, call your doctor. In rare cases, there may be an allergy, digestive problem, or other problem that needs medical attention.

It also may help your doctor to properly diagnose the problem (if there is one) if you keep a record of exactly how often and how much your baby seems to be spitting up. He or she should be able to tell you if it's normal or something that's cause for concern.

But again, it's important to remember that spitting up is usually perfectly OK. If the doctor says your baby's spitting up is normal, here are some ways to help alleviate it:
♂Burp your little one every 3 to 5 minutes during feedings.
♂Try giving smaller feedings more frequently.
♂Hold your baby upright after feedings.
♂Don't jiggle, bounce, or actively play with your baby right after feedings.
♂Make sure the nipple hole in your baby's bottle is the right size for your baby. For example, fast flows may cause babies to gag or may simply give them more than they can handle, whereas slower flows may be frustrating to some babies and may cause them to suck more vigorously and gulp too much air.
♂Keep your baby's head above his or her feet while feeding (in other words, don't hold your baby in a dipped-down position when feeding).
♂Raise the head of your baby's crib or bassinet. Roll up a few small hand towels or receiving blankets (or buy special blocks) to place under (not on top of) the mattress. But don't use a pillow under your baby's head, and always put your baby on his or her back to sleep.

Also, keep in mind that many babies grow out of spitting up by the time they're 1 year old.

8ㄝHow do I safely switch to a different formula?

Before making the decision to switch, be sure to talk to your doctor. Parents often assume that formula plays a part in a baby's fussiness, gas, spitting up, or lack of appetite. But often that's not the case.

If giving the OK to switch formulas, your doctor will recommend a way to do it so that your baby's feedings and digestion aren't interrupted. The doctor may suggest mixing the two formulas together little by little, then eventually eliminating the original formula altogether.

Reviewed by: Larissa Hirsch, MD
Date reviewed: March 2009

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FAQs about Baby Formula, Bottle Feeding and Infant Nutrition
http://www.infantformula.org/faqs

Choosing the best baby formula
http://www.babycenter.com

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FAQs about Baby Formula, Bottle Feeding and Infant Nutrition
http://www.infantformula.org/faqs

Following are frequent questions and answers on infant formula, breastfeeding, and related nutrition topics.

Breastfeeding and Infant Nutrition
♂What Are The Advantages To Breastfeeding?

Infant Formula Forms and Use
♂What Are The Various Forms Of Infant Formula?
♂What Is The Difference Between Milk-Based And Soy-Based Infant Formulas?
♂What Nutrients Are Present In Infant Formula And Why Are They Included?
♂Why Shouldn't I Feed Just Plain Cow's Milk To My Baby?
♂Is It Ok To Add Cereal To My Baby's Bottle?
♂Should I Stop Using Infant Formula When My Baby Starts Eating Solid Foods?

Infant Formula Preparation and Storage
♂Should I Sterilize Bottles And Use Boiled Water When Making Infant Formula?
♂Should I Use An Infant Formula Product Beyond Its Expiration Date?
♂How Long Can Infant Formula Be Kept After Opening?
♂How Long Can A Bottle Of Infant Formula Remain Unrefrigerated?
♂Should I Reheat A Bottle After Feeding Part Of It To My Baby?
♂Should Infant Formula Be Frozen?
♂Can Infant Formula Be Heated In A Microwave Oven?

Infant Formula Regulations
♂Are Infant Formulas Required To Meet Government Standards?
♂What Testing Is Performed To Assure That Infant Formula Is Safe?

Melamine and Cyanuric Acid
♂What is melamine?
♂Do infant formulas contain melamine?
♂Is melamine in foods a health risk?
♂What is cyanuric acid?
♂Do infant formulas contain cyanuric acid?
♂Is cyanuric acid in food a health risk?
♂Is cyanuric acid present in other foods?
♂Why would trace quantities of cyanuric acid be present in infant formula?
♂Have safe limits for melamine and cyanuric acid in foods been established?
♂Does the presence of cyanuric acid mean that melamine is present?
♂Do formula companies test for melamine? If so, has it been detected in the product?
♂What should parents do?

Perchlorate
♂What is perchlorate?
♂Does perchlorate affect the thyroid gland?
♂What impact does iodine have on perchlorate?
♂Do infant formulas contain iodine?
♂Are there safe limits for perchlorate?
♂Are the trace quantities of perchlorate in food a health risk?
♂Which companies' products were tested by CDC for the presence of perchlorate?
♂Do infant formula manufacturers test product for the presence of perchlorate?
♂How are infant formula manufacturers limiting the amount of perchlorate that could be in their products?
♂What kind of water should I use to reconstitute my baby's formula?
♂What levels of perchlorate were detected in infant formula and how do they compare to the RfD?

♂What Are The Advantages To Breastfeeding?

Breast milk provides an infant with the proper balance of nutrients required for growth and development without straining an infant's developing digestive and kidney systems. Breast milk also contains substances that help protect infants from certain infections. Nursing is convenient since breast milk is always available and does not require preparation or storage. Additionally, both mother and infant can benefit psychologically through this close and warm interaction. The American Academy of Pediatrics recommends breast feeding as the preferred mode of feeding. It states, "Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth. Infants weaned before 12 months of age should not receive cow's milk feedings but should receive iron-fortified formula." *

*The AAP further states, "Gradual introduction of iron-enriched solid foods in the second half of the first year should complement the breast milk diet. It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired."

♂What Are The Various Forms Of Infant Formula?

Baby formula is available in three forms: ready-to-feed, concentrated liquid and powder. Ready-to-feed is used "as is." Concentrated liquid (the only liquid that comes in a 13 ounce can) and powder must be diluted with water according to instructions on the label. Ready-to-feed and concentrated liquid baby formulas are commercially sterile. Powdered formulas are not sterile. Preparation of any form of infant formula (especially powdered products) requires careful handling to prevent contamination and minimize growth of microorganisms. Manufacturer's instructions should be followed in all cases.

A graphic depicting the addition of water and the statement "add water" are found on concentrated formula containers. Because ready-to-feed and concentrated formulas are both liquids, anyone caring for your child should be made fully aware of what form of formula you use, and whether or not water must be added. (Powdered infant formula containers also provide a graphic depicting the major preparation steps for that formula.)

♂What Is The Difference Between Milk-Based And Soy-Based Infant Formulas?

The protein in milk-based formulas comes from cow's milk which has been heat treated, making it easy for a baby to digest. The sugar in milk-based formulas is lactose, unless specifically manufactured as lactose-free. Soy-based formulas are milk-free and lactose-free; the protein in these formulas comes from a soybean source that also is easy for a baby to digest. If a baby exhibits signs of lactose intolerance or certain allergic reactions to milk protein, the physician may recommend a soy-based formula to help treat these conditions. A baby with confirmed milk protein-induced colitis could also be sensitive to soy protein so might be given an extensively hydrolyzedsate formula, one in which the protein has been predigested so it will decrease the likelihood of a reaction. Parents who seek a vegetarian-based diet for their healthy infant may want to discuss the use of soy-based formula with the pediatrician.

♂What Nutrients Are Present In Infant Formula And Why Are They Included?

Baby formulas contain energy-providing nutrients (protein, carbohydrate and fat) as well as water (an essential nutrient) and appropriate vitamins and minerals. The energy nutrients provide the calories necessary to maintain bodily functions, support activity, and promote growth. They also support desirable immune functions as an outcome of overall nutrition. Protein provides the building blocks necessary to form and repair tissue. Vitamins and minerals are essential in the metabolism of energy nutrients. Minerals play an important part in bone structure, regulate certain body functions and, together with water, help maintain the body's water balance.

Standard iron-fortified baby formulas are nutritionally complete foods for normal infants. When a physician recommends a formula not fortified with iron, another source of iron should also be recommended. A physician may recommend fluoride supplementation to infants at least 6 months of age only if the water supply is severely depleted of fluoride.

U.S. manufacturers of infant formula currently offer formulas containing docosahexanoic acid (DHA) and arachidonic acid (ARA), two nutritional fatty acids considered to be "building blocks" for the development of brain and eye tissue. Formulas containing DHA and ARA have been shown to provide visual and mental development similar to the breastfed infant.

♂Why Shouldn't I Feed Just Plain Cow's Milk To My Baby?

Cow's milk (e.g., whole, 2%, 1%, 1/2% or skim) is not appropriate for children under the age of one year, according to the Committee on Nutrition of the American Academy of Pediatrics. Cow's milk is a poor source of iron, and iron deficiency anemia is the most common nutritional problem in infants. Cow's milk that has not been specially heat processed (such as the heat processing used in infant formula) can cause intestinal blood loss in some babies. Iron is lost with the blood. Also, the levels of protein and sodium in cow's milk are higher than recommended for infants. Additionally, cow's milk is low in vitamin C, vitamin E and copper. Further, cow's milk contains butterfat that is difficult for a baby to digest. For these reasons, the Committee on Nutrition recommends that breastfeeding or iron-fortified infant formula be continued during the first year of life.

♂Is It Ok To Add Cereal To My Baby's Bottle?

According to the American Academy of Pediatrics, "Cereal should not be added to bottles except for medically-indicated reasons (e.g., gastroesophageal reflux) because this practice deprives children of the opportunity to learn to feed themselves." Note, "there is no nutritional indication to add complementary foods to the diet of the healthy term infant before age 4 months."

♂Should I Stop Using Infant Formula When My Baby Starts Eating Solid Foods?

No. The nutrient content of various baby foods, either commercially prepared or homemade, varies considerably. Additionally, during the period of transition when an infant is gradually increasing both the type and the amount of solids being eaten, the formula still contributes substantially toward meeting the infant's nutrient requirements. During this time, either breast milk or iron-fortified infant formula can most appropriately meet these requirements. The Committee on Nutrition of the American Academy of Pediatrics recommends that either breastfeeding or iron-fortified infant formula be continued during the first year of life, even after solids have been introduced.

♂Should I Sterilize Bottles And Use Boiled Water When Making Infant Formula?

Sterilization of all equipment and water used in preparing infant formula is commonly recommended until a health professional decides it is unnecessary. Check with your physician. When you are preparing infant formula, your own personal cleanliness, as well as that of any utensils that you use, is important.

The American Dietetic Association does not recommend preparing formula with boiling hot water due to problems with physical stability of the formula (e.g., clumping or separation) and nutrient degradation.

♂Should I Use An Infant Formula Product Beyond Its Expiration Date?

No. All infant formula containers carry "use by" or "use before" dates to ensure that the consumer receives a wholesome, high-quality product. Formula should not be bought or fed beyond the expiration date. After the expiration date, some vitamin levels decrease and changes in physical properties, such as discoloration and separation of fat, may occur. Infant formula companies have a reimbursement program covering outdated products and company policy encourages stores not to sell outdated products. Any formula that is out-of-date at the time of purchase should be returned to the store from which it was purchased for exchange or reimbursement.

♂How Long Can Infant Formula Be Kept After Opening?

An open can of liquid infant formula can be kept for up to 48 hours, if tightly covered and immediately placed in the refrigerator. Bottles of formula made from liquid should be refrigerated and used within 48 hours.

Formula that is prepared from powder and placed in bottles for feeding should be refrigerated and used within 24 hours. The remaining powder should be tightly covered and stored in a cool, dry place and used within a month after opening.

♂How Long Can A Bottle Of Infant Formula Remain Unrefrigerated?

Baby formula that is removed from refrigeration should be used within two hours or discarded. Because of possible bacterial contamination, formula remaining in a bottle one hour after the start of feeding should also be discarded.

♂Should I Reheat A Bottle After Feeding Part Of It To My Baby?

No. Once a baby has nursed from a bottle, microorganisms from the baby's mouth are introduced into the formula. If any unused portion of formula is refrigerated and reheated, these microorganisms will have the opportunity to multiply. Neither refrigeration nor reheating will prevent this growth. Therefore, you should fill each bottle with only the amount of formula needed for one feeding. After feeding, if any formula remains unused in the bottle, it should be discarded.

♂Should Infant Formula Be Frozen?

The use of infant formula after freezing is not recommended. Although freezing does not affect nutritional quality or sterility, physical separation of the product's components may occur.

♂Can Infant Formula Be Heated In A Microwave Oven?

Microwave ovens should NEVER be used for heating infant formulas since there is a danger of overheating the liquid. During the microwaving process, the bottle may remain cool while hot spots develop in the formula. Overheated formula can cause serious burns to the baby.

♂Are Infant Formulas Required To Meet Government Standards?

Yes. All infant formulas marketed in the U.S. must comply with the Infant Formula Act of 1980 and subsequent amendments passed in 1986. The nutrient levels specified by law are based on the recommendations of the Committee on Nutrition of the American Academy of Pediatrics and are periodically reviewed as new information arises.

♂What Testing Is Performed To Assure That Infant Formula Is Safe?

Infant formula is tested for 29 nutrients (as defined by the Infant Formula Act) to assure that each batch provides the appropriate nutrition for infants. In addition, IFC member companies carefully monitor the ingredients used in infant Formula to help assure that product quality is not compromised.

♂What is melamine?

Melamine is a nitrogen rich compound that is approved for a wide variety of industrial applications, including cleaning products and in pesticides and fertilizers. It is also approved for use in food packaging and tableware.

Melamine is not allowed to be added to foods, but very low background levels may be present as a result of these other uses.

♂Do infant formulas contain melamine?

Trace amounts of melamine have been detected in very few U.S. infant formulas by the U.S. FDA and Health Canada. However, according to the FDA, the background levels detected were orders of magnitude less than the levels reported in 2008 in Chinese-manufactured milk products intentionally contaminated with melamine. The FDA issued a statement confirming that all infant formulas manufactured in the US are safe.

The FDA's results are consistent with similar findings from Health Canada, which recently surveyed infant formulas sold in Canada using an even more sensitive testing method than the FDA method. Health Canada detected very low background levels of melamine in several formulas it tested and clearly stated that none of the samples exceeded their revised standard of 0.5 parts per million (ppm) and that none would represent a risk to Canadian infants.

In both cases, the trace amounts of melamine found in infant formula were well within the margin of safety established by international authorities.

♂Is melamine in foods a health risk?

The World Health Organization (WHO) has noted that melamine is commonly found throughout the environment because it has many approved uses and has established a tolerable intake level representing the amount of melamine that a person can ingest on a daily basis without appreciable health risk. (Levels in food typically fall far below this level and do not pose a health risk.) According to the WHO and numerous other regulatory agencies, the very low levels of melamine in the environment and in some foods do not pose a health risk.

By contrast, the very high levels of melamine found in some milk ingredients and milk powders in China - which caused renal illnesses - were the result of intentional addition of melamine to foods, which is illegal.

♂What is cyanuric acid?

Cyanuric acid is an analogue of melamine. It is an FDA-approved component of some sanitizers commonly used in food manufacturing sites and in the household, and it may be found in chemically purified drinking water following the World Health Organization (WHO) guidance for safe drinking water.

♂Do infant formulas contain cyanuric acid?

Trace levels of cyanuric acid have been detected in very few U.S. infant formulas (three samples of one product tested positive). However, according to safety standards issued by the WHO and FDA, the trace amounts reported are much too low to be considered a safety concern.

♂Is cyanuric acid in food a health risk?

Due to the extremely large margin of safety and the recognized positive public health benefit for use of cyanuric acid salts, the U.S. FDA affirms there is no reason to question the safety of a trace amount of cyanuric acid in foods or formula products.

♂Is cyanuric acid present in other foods?

Yes. In the World Health Organization Guidelines for Drinking-Water, the typical concentration of cyanuric acid resulting from maintaining microbiological safety is approximately 40 mg/L of water. That, for comparison, is approximately 80 times greater than the minute levels of cyanuric acid reported to have been found by the FDA in infant formula.

♂Why would trace quantities of cyanuric acid be present in infant formula?

Minute quantities (parts per billion) of residual sanitizer used to clean formula-processing equipment, utensils and packaging may sometimes be detected with modern analytical technology that is capable of measuring ultra trace quantities of chemical substances. Sanitizing formula-processing equipment is a key step in making infant formula, as it protects the integrity of the formula. Concentrations at these extremely low levels, if they occur at all, are not a food safety concern and have no effect on the final product, similar to finding water spots on dishes.

Since melamine and cyanuric acid have a variety of industrial uses, low levels can be found within the environment and in foods.

♂Have safe limits for melamine and cyanuric acid in foods been established?

In November 2008, FDA concluded that "levels of melamine alone or cyanuric acid alone, at or below 1 part per million (ppm) in infant formula do not raise public health concerns." The FDA added their "ongoing investigation continues to show that the domestic supply of infant formula is safe and that consumers can continue using U.S. manufactured infant formulas."

In December 2008, the World Health Organization established a tolerable daily intake (TDI) of 0.2 milligrams per kilogram of bodyweight per day for melamine. Health Canada has adopted the WHO recommendation, and has established a safe limit of 0.5 parts per million for melamine in infant formula.

♂Does the presence of cyanuric acid mean that melamine is present?

No. It does not mean that melamine is present. Melamine and cyanuric acid are compounds in the same chemical family. The FDA- approved uses of cyanuric acid can result in ultra-trace amounts of cyanuric acid in food products.

♂Do formula companies test for melamine? If so, has it been detected in the product?

Companies testing for melamine use a published U.S. FDA testing methodology. Given the many approved uses of melamine it is not unexpected to find background levels in infant formula. The extremely low trace levels that have been detected are below the limits deemed safe by the WHO.

♂What should parents do?

Breastfeeding is ideal, but for a mother who cannot or chooses not to breastfeed, infant formula remains the only safe alternative to nourish her baby. FDA has stated that "there's no basis for concern because we're talking about trace levels that are so low ... that there's absolutely no risk." No changes in feeding practices are recommended. Infant formula is safe and nutritious. FDA also stated: "Parents using infant formula should continue using U.S. manufactured infant formula. Switching away from using one of these infant formulas to alternate diets or home-made formulas could result in infants not receiving the complete nutrition required for proper growth and development."

♂What is perchlorate?

Perchlorate is a colorless, odorless substance that is prevalent throughout the environment and the food supply. Perchlorate occurs naturally in both potash ore and in arid states of the Southwest United States, and in nitrate fertilizer deposits in Chile; it can also form naturally in the atmosphere. It is also manufactured and used as a component (oxidizer) of rocket fuels, explosives and fireworks. Perchlorate is not an ingredient in infant formula. However, because perchlorate is present in the environment, including in the drinking water supply and the food supply chain, trace levels may be found in infant formula and in breast milk and do not pose a health risk.

♂Does perchlorate affect the thyroid gland?

High levels of perchlorate (above 245 parts per billion [ppb]) can temporarily affect the thyroid's ability to absorb iodide from the bloodstream. However, these effects are thought to be reversible upon removal of perchlorate with no cumulative effects. According to the Perchlorate Information Bureau, a human would have to consume 14,000 ppb of perchlorate in drinking water daily to result in adverse effects.

♂What impact does iodine have on perchlorate?

Iodine has been shown to counteract the potential effects associated with perchlorate. Additionally, the National Academy of Sciences found that perchlorate is not metabolized, is not stored in the body, and any effects of perchlorate on the thyroid are reversible once exposure stops.

♂Do infant formulas contain iodine?

All infant formulas manufactured in the U.S. contain iodine, as required by law, to aid in the development of the baby's brain and thyroid.

♂Are there safe limits for perchlorate?

Yes; in 2003 the National Research Council of the National Academy of Sciences recommended a Reference Dose (RfD) of 0.7 micrograms per kilogram body weight per day (mcg/kg bw/d) for perchlorate. The U.S. Environmental Protection Agency (EPA) defines RfD as "an estimate (with uncertainty spanning perhaps an order of magnitude) of a daily oral exposure to the human population (including sensitive subgroups) that is likely to be without an appreciable risk of deleterious effects over a lifetime." In 2005, the EPA adopted the RfD, which includes a 10-fold safety factor. This means if the RfD were 10-times larger there would likely be no appreciable risk of deleterious effects over a lifetime.

♂Are the trace quantities of perchlorate in food a health risk?

No. Due to the large safety factor associated with the EPA RfD, the trace levels of perchlorate that have been detected in food do not pose a health risk. FDA has stated they do not recommend that people alter their diet or eating habits because of perchlorate. Additionally, neither the World Health Organization, nor U.S. or European health agencies, have issued health warnings regarding perchlorate.

♂Which companies' products were tested by CDC for the presence of perchlorate?

We do not know which companies' products were tested. CDC did not identify brand names.

♂Do infant formula manufacturers test product for the presence of perchlorate?

Since the FDA has determined the trace amounts of perchlorate that may be present in food products do not pose a health concern to humans, including infants, and because perchlorate is not an added ingredient to infant formula, manufacturers do not test finished products for the presence of perchlorate.

♂How are infant formula manufacturers limiting the amount of perchlorate that could be in their products?

As an industry, members of the IFC take all safety issues very seriously. Our research and development programs are targeted to produce the highest quality of infant formula products available. And our quality assurance process starts at the farm level and continues throughout the manufacturing process. The water used to manufacture infant formula is filtered to ensure its safety and quality.

♂What kind of water should I use to reconstitute my baby's formula?

In January 2009, the EPA released an interim drinking water health advisory of 15 parts per billion (ppb) for perchlorate, which is based on the NRC RfD of 0.7 mcg/kg bw/d. According to the FDA, most municipal water supplies do not contain levels of perchlorate that exceed 15 ppb. However, if you are concerned with the perchlorate levels in your drinking water supply, the FDA advises that you should use bottled water or water that has been filtered from a home treatment system that has been certified to remove perchlorate. If you are unsure about your municipal water supply, we recommend that you contact your baby's doctor, or your local water utility, or go to this web site www.epa.gov/safewater/dwinfo/index.html.

♂What levels of perchlorate were detected in infant formula and how do they compare to the RfD?

According to the CDC study, the average perchlorate concentration of milk-based powder infant formula studied was 1.72 ppb. To put this into perspective, this level is more than eight times lower than the level determined by the EPA to be safe in drinking water. Using the estimates for exposure described in the CDC study, infants who consume formula containing these average levels and prepared with perchlorate-free water would not exceed the RfD.

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Choosing the best baby formula
http://www.babycenter.com

Highlights
♂I'm bottle-feeding my baby. Which formula is best?
♂Forms of formula
♂Types of formula
♂What's in formula? How do formulas differ?
♂Are generic brands nutritionally adequate?
♂Can I make my own formula?
♂What about adding cereal or milk to my baby's formula?
♂What if I'm still not sure?

1ㄝI'm bottle-feeding my baby. Which formula is best?

It's easy to feel overwhelmed in the formula aisle. Choosing the best nourishment for your baby is a pretty weighty decision, and there are lots of choices. When choosing a formula, you'll want to consider the form it comes in (ready-made, concentrate, or powdered), the type of protein it uses (cow's-milk-based formula is the most popular, but there are other options), and what other ingredients are included (such as DHA and iron).

Here's what you need to know:

2ㄝForms of formula

Formula Feeding Problem Solver

If your baby's having any problems with formula feeding, our tool can help.
Formulas come in three basic forms: ready-made, concentrate, and powdered.

Note: You may also want to consider concerns about the chemical bisphenol A (BPA) in cans and bottles. Powdered formula is considered a safer choice because it contains far less BPA. Read more about BPA.

Ready-to-use formula is undoubtedly the most convenient 〞 no mixing or measuring required, just open and serve. It's hygienic and especially helpful in circumstances where you might not have access to safe water. It's also a good choice if your baby was born with a very low birth weight or is otherwise immuno-compromised, because it's sterile. But for everyday use, the convenience of ready-to-use formula comes at a price 〞 ready-to-use formula costs about 25 percent more per ounce than powdered formula. The containers also take up more storage space in your cupboard and more space in the landfill, unless you can recycle all of the cans or bottles. Once opened, ready-to-use formula has a short lifespan 〞 it must be used within 48 hours. Also, because it often has a darker color than powdered formula, many moms complain that it's more likely to stain clothes.

Liquid concentrate formula requires you to mix equal parts of water and formula, so read the instructions on the container carefully. Compared to ready-to-use formula, concentrate is less expensive and takes up less storage space. Compared to powdered formula, it's a little easier to prepare but more expensive.

Powdered formula is the most economical choice and the most environmentally friendly. It takes up the least amount of space in transport, in your pantry, and in your trash can. Powdered formula takes more time to prepare than other types of formula, and you must follow the directions exactly, but it has a one-month shelf life after the container has been opened. Besides, you can mix up just the right amount whenever you need it 〞 as much or as little as you want 〞 which is especially helpful if you're a breastfeeding mom who may only need an occasional supplemental bottle for your baby.

3ㄝTypes of formula

There's a formula to suit every baby's needs.

Cow's-milk-based formula: Most formula available today has cow's milk as its main ingredient. The protein in the milk is significantly altered to make it easier to digest, because your baby won't be ready to digest regular cow's milk until after his first birthday.

Soy-based formula: If you're a vegan, or if your baby has trouble digesting cow's milk protein, the doctor may suggest a soy-based formula. These are made with a plant protein that, like the protein in cow's milk, is modified for easy digestion by babies. You may also want to talk with your baby's doctor about giving soy-based formula a try if your baby has colic. The evidence isn't conclusive, but some research suggests it's worth a try.

Lactose-free formula: If your baby is lactose-intolerant or unable to digest lactose, the sugar naturally found in milk, his doctor will recommend a lactose-free formula in which the lactose is replaced with a different sugar, such as corn syrup.

Extensively hydrolyzed formula: In these formulas, the protein is broken down into smaller parts that are easier for your baby to digest than larger protein molecules. Your baby may need a hydrolyzed formula if he has allergies or trouble absorbing nutrients. The doctor may also suggest trying a hydrolyzed formula if your baby has colic.

Formulas for premature and low-birth-weight babies: These formulas often contain more calories and protein, as well as a more easily absorbed type of fat called medium-chain triglycerides.

Human milk fortifier: This product is used to enrich the nutrition of breastfed babies who have special needs. Some are designed to be mixed with breast milk, and some can also be fed alternately with breast milk.

Metabolic formulas: If your baby has a disease that requires very specialized nutrition, he may need one of these specially developed formulas.

4ㄝWhat's in formula? How do formulas differ?

There are six main ingredients in formula: carbohydrate, fat, protein, vitamins, minerals, and other nutrients. What makes one brand of formula different from the next is the specific carbohydrate or protein it uses, as well as any additional ingredients it includes. For example, casein and whey are two kinds of cow's milk proteins that are found in various proportions among different brands of cow's-milk-based formula.

It's very easy to get confused by all of the items listed on the ingredient label. Below, we guide you through the maze of ingredients, and compare them to those found in breast milk.

Carbohydrate: Lactose is the main carbohydrate source in breast milk, and it is also the primary carbohydrate source in cow's-milk-based formulas. Corn maltodextrin is sometimes used as a secondary source of carbohydrate. Lactose-free, soy, and special formulas contain one or more of the following carbohydrates: sucrose, corn maltodextrin, modified cornstarch, or corn syrup solids.

Protein: Breast milk contains about 60 percent whey and 40 percent casein. Most formulas have similar protein content. Others contain 100 percent whey. Some studies indicate that whey protein is digested faster than casein, which could be beneficial for babies with gastroesophageal reflux disease (GERD).

Soy formulas contain soy protein isolate. Some brands use partially hydrolyzed soy protein to encourage easier digestion.

Sometimes the protein in formula is partially hydrolyzed, or broken down. Partially hydrolyzed formulas are not hypoallergenic 〞 don't use one if your baby has a protein allergy, or even if you suspect he may have one. However, partially hydrolyzed whey formulas have been shown in one study to reduce atopic dermatitis, compared to standard cow's-milk formula.

Extensively hydrolyzed formulas contain extensively broken-down casein with additional amino acids, which are the building blocks of protein. These formulas are considered hypoallergenic and are used for babies who have a protein allergy.

Fat: Breast milk contains a blend of monounsaturated, polyunsaturated, and saturated fat. Formulas use a variety of oils to match the fat makeup of breast milk. They include soy oil, coconut oil, corn oil, palm or palm olein oil, and high oleic sunflower oil. Although palm and palm-olein oil are widely used, research has shown that these fats can reduce absorption of fat and calcium from formula. In other words, your baby may not absorb as much fat and calcium as he would from a formula that doesn't contain these oils.

Medium-chain triglycerides require less effort to digest and are more easily absorbed. They're used in special formulas for premature infants and for infants who have trouble digesting or absorbing nutrients.

The FDA has approved the addition of two long-chain fatty acids to formula: DHA (docosahexaenoic acid) and ARA (arachidonic acid). Both of these substances are found in breast milk when the mother's diet is adequate, and both are important for brain and vision development. Babies get DHA and ARA from their mother during the third trimester, but the transfer is cut short when a baby is born prematurely. All babies need a continuing supply of both substances throughout their first year.

Two studies published in April 2005 support the supplementation of formula with DHA and ARA. One, a report published in the American Journal of Clinical Nutrition, showed that full-term infants fed DHA- and ARA-supplemented formula had significantly better visual acuity than infants who did not receive the supplements. And a study published in The Journal of Pediatrics states that DHA and ARA enhance both cognitive and physical growth in preterm infants.

There aren't any long-term studies confirming the safety of these substances, although there's no evidence suggesting that these additives are harmful to babies, either. Formulas that include DHA and ARA are priced about 15 percent higher than standard formula. The American Academy of Pediatrics (AAP) has not taken a position on whether these fatty acids should be added to formula.

Vitamins and minerals: Most words on the ingredient label describe vitamins and minerals. These words can be hard to figure out 〞 ferrous sulfate is iron, for example, sodium ascorbate is vitamin C, and calcium pantothenate is a B vitamin.

The AAP recommends that all healthy babies who aren't breastfed exclusively be given iron-fortified formula until they reach their first birthday. It's important that babies receive the minimum recommended amount of iron (4 mg of iron per liter) to prevent iron-deficiency anemia.

Anemia inhibits the blood's ability to circulate oxygen, which all of the body's cells need to function properly. Studies have shown that getting enough iron in the first year of life is important for success in school later on. A baby's iron stores are established in the last trimester, so it's especially important for premature babies to get plenty of iron.

Most formulas contain at least 4 mg of iron per liter, although "low-iron" formulas are still on the shelves. These were developed years ago in response to the misconception that iron causes constipation. The AAP would like these low-iron formulas to be discontinued or labeled as nutritionally inadequate.

Other ingredients Here's where the different brands tweak their formulas to make them stand apart from one another.

Nucleotides: These are the building blocks of DNA and RNA, naturally present in breast milk. They have several functions and may aid in immune system development. Different brands of formula have different amounts of nucleotides added.

Rice starch: Rice starch is added to "anti-regurgitation" formula. Some research shows the pre-thickened formula does result in less spitting up and choking. However, other research indicates there may be the same amount of acid reflux regardless. Ask your baby's doctor before using an "AR" formula to help with your baby's spitting up.

Dietary fiber: Soy fiber is added to soy formula for the temporary treatment of diarrhea. The only formula containing fiber is Isomil DF, which is clinically shown to reduce the duration of diarrhea.

Amino acids: Amino acids such as taurine, methionine, and carnitine are added to soy formulas, and sometimes to cow's-milk formulas, to match the amount of amino acids in breast milk.

"Designer" formula: This formula is unique in that it has a protein ratio similar to breast milk, but the proteins are partially broken down to aid digestion. It also has 25 percent less lactose than regular formula.

5ㄝAre generic brands nutritionally adequate?

Generic brands of formula must meet requirements from the federal Food and Drug Administration (FDA) for nutrients in formula, so in many instances, the only difference between generic and brand name is the price. Whether you're buying generic or name brand, though, take a minute to look at the label before you purchase the formula. Specific ingredients do vary from brand to brand, and this can make a difference to your baby.

6ㄝCan I make my own formula?

No. It would be impossible to include all of the ingredients in the right amounts for your baby. Homemade formula could lead to failure to gain weight, malnourishment, or even death.

7ㄝWhat about adding cereal or milk to my baby's formula?

Never add vitamins, cereal, fatty acids, olive oil, regular cow's milk, or any other ingredients to your baby's formula unless your doctor recommends it. Formula is a carefully developed substance with precise amounts of dozens of nutrients. Adding anything to formula could jeopardize your baby's health.

Olive oil, for example, can lead to permanent lung damage and even death, because of the danger of inhaling the oil into the lungs when spitting up. Because cow's milk is so hard for babies to digest, never mix cow's milk with formula or give it to your baby straight until he's at least 1 year old. And adding breast milk to formula is a waste of breast milk if your baby doesn't drink the entire bottle.

8ㄝWhat if I'm still not sure?

If you've decided to feed your baby formula and you're still baffled by the many options available, or you're considering switching formulas, talk with your baby's doctor. She'll consider your baby's health, age, and nutritional needs and make an appropriate recommendation. She can also monitor your baby's reactions and investigate any symptoms. Don't try to diagnose an allergy or sensitivity on your own. You could miss a serious underlying condition or prevent your baby from getting adequate nutrition.

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