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

• Cow's-milk-based formulas 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 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 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 child's 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.

Some formulas are advertised as having DHA and ARA. What are they and should my baby's formula have them?

DHA (docosahexaenoic acid) and ARA (arachidonic acid) are new ingredients that weren't used in any infant formulas sold in the United States until 2002 (although they've been available in Europe since 1996). Now they can be found in some, but not all, milk- and soy-based formulas.

DHA and ARA are polyunsaturated fatty acids (consider 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 contribute to weight gain and provide benefits to premature infants. Although it isn't clear whether these formulas are beneficial over the long term, they do show some short-term benefits and are worth considering.

Formula can be expensive. Is there any way to reduce my formula costs a little?

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:

• Be sure to take home all of the coupons and freebies given in the hospital after your delivery. Formula companies often provide new moms with free bottle-cooling bags and formula, and sometimes even diaper bags. If you aren't automatically given one (or more) during your stay, just ask the nursing staff.
• 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 day care 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 out 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 - at the grocery store or wholesale store, 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 child's doctor for freebies - many receive tons of formula from the formula companies and may be willing to dole some out to their patients if asked.

What kind of bottle should I use?

Many different types of bottles are available. They may be standard reusable (which come in many varieties, such as wide-mouthed and angled) or reusable with disposable sterilized liners or drop-ins (good for quick clean-ups but you'll need a steady supply of new liners). You may need to try a few different brands before you find the combination that works best for you and your baby.

What 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), neither of which is better than the other. 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 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. A nipple's hole is the right size, says the AAP, if you hold the bottle upside down and a few drops come out and then stop.

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 or one with a larger - or smaller - hole to see if it makes any difference.

How often will I need to buy new nipples?

That depends on how the nipples you're using hold up to cleaning, sterilizing, and everyday use. Be sure to check nipples regularly for signs of wear and replace them often. Also, as your baby grows, he or she may or may not prefer nipples that come in different sizes and flows (the holes get bigger as babies get older and are ready to handle faster flows).

What are follow-up formulas?

For older babies from 4 to 12 months of age, some manufacturers offer follow-up formulas with more calories and nutrients. But every child's nutritional needs are different. Before starting your baby on a follow-up formula - or any formula different from the one you've been giving - talk to your child's doctor about whether this is right for your little one.

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