Introduction

Breastmilk is always the recommended first feeding choice for babies and exclusive breastfeeding is recommended up until 6 months of age.

When exclusive breastfeeding is not possible or has stopped before a baby reaches 12 months of age, commercial infant formula is the only safe alternative.

A standard formula will meet all the nutritional needs of babies in their first year of life. Solids should be introduced at approx. 6 months of age with milk feeding (breastfeeding or formula) continuing until 12 months of age.

It is important to follow the instructions on the tin when preparing formula. The feeding amounts specified on the tin should be used as a guide only, and babies will drink varying amounts.

Always supervise your baby during feeding. Do not leave your baby on their own with a bottle, and never prop up a bottle for your baby. Propping up a bottle places your baby at risk of choking or developing an ear infection.

 Things to consider

There is a wide range of brands and types of infant formula in Australia which can make choosing a formula confusing.

Frequent formula changes between brands is not recommended. If you feel your baby is not tolerating a formula, speak to your health professional for advice.

Infant formula products are regulated under the Australia and New Zealand Food Standards. There are three types of products covered by this standard:

  1. infant formula (suitable for infants aged 0 - <12 months)
  2. follow-on formula (suitable for infants aged from 6 - <12 months)
  3. infant formula suitable for special dietary use

 Management

Categories for standard formula

  1. Step one, starter, newborn, or 0-6 months (safely use from birth to 12 months)
  2. Step 2 or follow on (for babies over 6 months)
  3. Step 3 or toddler formula (for toddlers over 12 months of age)

Note: A healthy toddler should not need formula and can be encouraged to drink regular milk or breastfeed as part of their daily dairy serves. Step 3 formula should not be given to babies under 12 months.

Different types of formulas

Cow’s milk formula

Cow’s milk based formula is the most common type of infant formula used. Modified cow’s milk formula aims to resemble breast milk as closely as possible. It contains lactose which is the sugar found in breast milk and cow’s milk.

Some brands offer “gold” or “optimum” varieties and claim to be superior in nutritional value compared to standard formulas. A standard formula is entirely adequate.

A2 formulaA2 formula is based on cow’s milk which contains the A2 protein, which is claimed to be less associated with digestive associated with digestive discomfort, however the evidence for this is limited.
OrganicOrganic infant formula is made from organic certified ingredients (such as milk that comes from cows not given growth hormones and which graze on grass not treated with synthetic fertilisers or pesticides).
Goat’s milk basedGoat’s milk based formula contains goat’s milk protein. Goat’s milk formula contains lactose. Goat’s milk formula is not suitable for babies who have an allergy to cow’s milk as the proteins in goat’s milk are very similar to cow’s milk.
Soy based

Soy based infant formula is a vegan alternative to cow’s or goat’s milk based formulas, and does not contain any animal products. Soy based formula is also lactose free. Soy based formula should not be used for allergy prevention. Babies who have an allergy or intolerance to cow’s milk proteins may also be allergic or intolerant to soy proteins.

Soy based formula is not recommended for infants under 6 months.

Formulas for special dietary use

Some formula brands have developed a range of products to address specific concerns/needs or requirements. We recommended that you speak to a health professional if considering the use of one of these formulas.

Rice based or plant based formulaRice based formulas are made from rice protein and available without a prescription, over-the-counter. They may be a suitable alternative for infants with allergies over extensively hydrolysed formula or soy based formula. A health professional should always provide direction as to when this type of formula should be used.
Lactose freeLactose free formulas are rarely required as lactose intolerance in infants is rare. Specific medical conditions may require a lactose free formula, however this should always be guided by a health professional.
AR or anti-regurgitationAR (anti-regurgitation) formulas are thickened formulas thought to reduce reflux in babies. Reflux is common in infants and typically resolves with time. It does not require treatment unless the baby also has poor weight gain or significant discomfort. AR formulas may reduce the volume or frequency of vomiting and discomfort after feeds.
Thickened feeds

Thickened feeds are another strategy utilised to manage reflux in infants prone to frequent spit ups. Unlike AR formula, commercially available thickeners can help allow for greater control over the desired consistency or thickness of the formula. Thickener can also be used with breast milk.

The food thickener used must be suitable for infants.

Hydrolysed formula

Hydrolysed formula can be partially hydrolysed or extensively hydrolysed. This means that the proteins in the formula have been broken down into smaller pieces.

We recommend that hydrolysed formula be commenced under the guidance of a health professional.

There are 3 types of hydrolysed formulas:

  1. Partially hydrolysed – the proteins are partially broken down. Partially hydrolysed formulas can be advertised as being gentler on the stomach or for constipation and colic, however evidence regarding this is limited. It is not suitable for infants with a cow’s milk protein allergy. Partially hydrolysed formula is usually more expensive than other types of formula.
  2. Extensively hydrolysed – the protein is broken down into small pieces called peptides. These formulas are used for diagnosed medical conditions including allergies and intolerances.
  3. Amino-acid based – also known as elemental formula. These contain no large or small protein particles as the protein is broken down into its basic building blocks, called amino acids.

Extensively hydrolysed and amino-acid based formulas are only available on prescription for infants with specific medical concerns that cannot tolerate commercially available formula, due to the allergies or intolerances. These formulas should only be used under the guidance of a health professional.

Disclaimer

This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.


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