Baby Formula Trends—A Brief History

Some parents or grandparents will remember that they used to be able to buy low-iron infant formula until a 1989 American Academy of Pediatrics Committee on Nutrition statement recommended that there was “no role for the use of low-iron formulas in infant feeding and recommends that iron-fortified formula is used for all formula-fed infants.” Before that, low iron infant formulas were sold because many parents believed that the iron in the formula could cause gas, colic, fussiness, and reflux, etc. Drinking low iron formula put those infants at risk for iron deficiency anemia, though. Low iron formula continued to be marketed and sold despite the fact that the AAP, as early as 1971, stated that they strongly recommend that “when proprietary formulas are prescribed that iron-supplemented formulas be used routinely as the standard.” This is a good example that while some new infant formulas have “true clinical indications,” others are used because of “parental preference,” especially those formulas that are “marketed for infant fussiness, colic, and perceived gastrointestinal issues.” That doesn’t seem to keep parents from buying them.

Standard Types of Baby Formula

Infant formulas are regulated by FDA’s Center for Food Safety and Applied Nutrition under the Federal Food, Drug, and Cosmetic Act. They mostly differ in their source of proteins (cow’s milk vs soy), sugar (lactose vs corn syrup), and fats (vegetable oils), etc., different combinations of which give rise to:

Milk-Based Baby Formula Soy-Based Baby Formula Elemental Baby Formula: Enfamil Nutramigen and Similac Alimentum Amino-based Baby Formula: PurAmino, EleCare, and Neocate are hypoallergenic formulas for infants with a severe allergy cow’s milk protein Specialized Formulas: BCAD 1 (for children with maple syrup urine disease) to Phenyl-Free (PKU) and Enfaport (Chylothorax or LCHAD deficiency), there are highly specialized formulas for children with rare conditions.

The latest additions to the old standards that many pediatricians recommended are baby formulas for spit-up and those for premature babies. Formulas for premature babies, including Enfamil Premature and EnfaCare and Similac NeoSure, make a lot of sense. They include more calories and calcium, which premature babies need. As you will see, many other types of baby formula are now actively promoted, but are most of these types of baby formulas actually necessary for kids? Probably not. For example, even the standard soy formula shouldn’t be used as often as it is. The American Academy of Pediatrics states that “that there are few circumstances in which soy formula should be chosen instead of cow milk-based formula in term infants. One of these situations is in infants with a rare disorder called galactosemia.” In other situations, when a baby has a true milk allergy, they should likely go straight to an elemental formula instead of soy, comfort, or gentle formula, as any of those will likely trigger the same symptoms. Elemental formulas are more expensive than other formulas, though, which may be why parents opt to try other formulas first. But then, if your baby’s symptoms got better on comfort or gentle formula, he very likely didn’t have a true milk allergy, since those also contain have milk proteins.

Even with all of the new types of baby formula listed below, the United States is actually a little late to the party when it comes to trends in baby formula. For example, Nestle launched their BabyNes pod-based baby formula preparation system in other countries way back in 2011 and you still can’t buy it here. Other baby formula trends that are active in the United States include:

Non-GMO Baby FormulaOrganic Baby FormulaBaby Formula for Breastfeeding SupplementationSensitive/Gentle/Comfort FormulaReduced Calorie Formula - while most infant formulas have a standard 20 calories per ounce, many Similac formulas have been reformulated to 19 calories per ounce to ‘better match the average caloric density of breast milk.’

And, of course, most of these infant formulas have added DHA and ARA. Some also have prebiotics and nucleotides. A few even have probiotics. Again, some new types of infant formula make a lot of sense. For example, many babies spit up and parents were already adding rice cereal to formula as an acid reflux treatment, so added rice formula seemed like a no-brainer. But what about formulas for colic? Experts don’t think that colic is caused by a feeding intolerance, so why do we need a special formula for colic. They also don’t think that many babies are born with lactose intolerance, so why do we need lactose-free or reduced-lactose formula? We probably don’t and keep in mind that those aren’t true health claims on those cans of baby formula. Instead, “formula companies are placing claims on their products that use language to imply product-disease relationships without making direct health claims that would be subject to premarket approval by the FDA.” So a marketing claim on the label says “for fussiness and gas due to lactose sensitivity,” instead of a true health claim like “reduces fussiness and gas.”

Baby Formula Stages

It started with Toddler Formulas, but there is now a ‘baby’ formulas for every stage of your younger child’s life, including:

NewbornsInfantsSupplementing infantsOlder infantsToddlers

But you probably don’t need to change formula two or three times simply because your baby is getting older. You also don’t need a special formula to supplement your breastfeeding baby. There is also concern that the way that these formulas are marketed, they might suggest to breastfeeding mothers that they should stop breastfeeding and switch to them when their baby reaches that age.

Store Brand Baby Formula

The availability of store brand formulas isn’t new. It is a new trend that these store-brand formulas are trying to keep up with all of the latest trends that we see in the big-name formula brands. So now we are seeing Tender, Gentle, Sensitivity, and Organic store brand formula. That’s a bit surprising from an industry that claims that a company’s “marketing department’s creativity” shouldn’t be the most important thing about a formula.

Baby Formula Confusion

With so many different types of baby formula now available, it shouldn’t be surprising that some parents are confused. In addition to confusion about which formula to choose for their baby if they aren’t breastfeeding, there is no confusion about the ingredients in the formula too. Should you worry about cane sugar in some organic formulas? What about the corn syrup in formulas? Isn’t that bad for them? Like breast milk, every baby formula has to have a source of carbohydrate or sugar. While breast milk and cow’s milk-based formulas use lactose (glucose plus galactose), other types of formula use sucrose (cane sugar) and corn syrup solids (glucose). And no, corn syrup solids have nothing to do with high fructose corn syrup, so you shouldn’t worry about feeding these types of formula to your baby if you need to.

Are New Baby Formulas Marketing Health or Hype?

Dr. Steven A. Abrams, in his commentary “Is it time to put a moratorium on new infant formulas that are not adequately investigated?” suggests that there are problems with having all of these new formulas. Unfortunately, this can cause anxiety for parents, especially if they think something is wrong with their baby. Other potential problems when so many formulas are marketed without evidence that they work include that:

They might compete with breastfeeding. Will a breastfeeding mom switch to a formula for reflux, gas, or colic if thinks her baby is having problems or use a supplementing formula unnecessarily?Many of the latest formula types are more expensive than standard formula, even if you choose store brand formula"Labeling infants who manifest varying degrees of normal infant crying with medical conditions such as lactose intolerance that they don’t have" can cause anxiety in parents

When thinking about switching to between these formulas, parents should understand that while infant formulas must meet specific nutrient specifications, they don’t need to be approved by the FDA before they can be marketed. We should all keep in mind that an Institute of Medicine report, “Infant Formula: Evaluating the Safety of New Ingredients,” found that “although existing federal guidelines and regulations for evaluating the safety of food ingredients have worked well for conventional substances (e.g., vitamins, minerals), they are not sufficient to address the diversity of potential new ingredients proposed by manufacturers to develop formulas that mimic human milk.” In addition to following the guidelines issued by that 2004 IOM report, we can help parents make evidenced-based choices for feeding their babies by adopting the 1981 World Health Organization International Code of Marketing of Breast-Milk Substitutes. Not surprisingly, the United States is not one of the 69 countries that have banned the advertising of infant formula directly to parents, which is covered by article 5 of the WHO Code. Dr. Abrams also suggests that it will be helpful to continue to implement the Baby Friendly Hospital Initiative in more hospitals and establish working groups to evaluate new formulas. Until then, talk to your pediatrician before you stop breastfeeding or you switch your baby’s formula.