FAQs
Following are frequent questions and answers on infant formula, breastfeeding, and related nutrition topics.
Breastfeeding and Infant Nutrition
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?
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.