What is the best infant formula milk?

Best Infant Formula Selection

For healthy term infants who cannot be breastfed, standard iron-fortified cow's milk-based formula is the recommended choice. 1

Primary Recommendation: Breastfeeding First

• Breast milk remains nutritionally superior to all formula options and should be the first choice whenever possible 1
• Exclusive breastfeeding is recommended for approximately the first 6 months of life, with continuation through the first year 1
• Breast milk provides lifelong health benefits including protection against infections, improved neurodevelopment, and reduced risk of chronic diseases 1
• When direct breastfeeding is not possible, expressed breast milk is the next best option 1

When Formula is Necessary: Standard Iron-Fortified Formula

If breast milk is unavailable, iron-fortified cow's milk-based infant formula is the evidence-based alternative for healthy term infants. 1, 2

Key Features of Standard Formula:

• Must be iron-fortified to prevent iron deficiency anemia, which is common when non-fortified options are used 1, 3, 4
• Standard dilution of 19-20 calories per ounce meets nutritional needs of healthy term infants 5
• All formulas are highly regulated and must meet strict FDA safety standards 5

Formulas NOT Recommended for Routine Use

Avoid These Without Medical Indication:

• Soy-based formulas: Not recommended for prevention of allergic disease or colic due to insufficient evidence of benefit 1, 2

  • Only indicated for specific conditions: congenital lactase deficiency and galactosemia 2
  • Risk of cross-reactivity in infants with cow's milk protein allergy (20-40% also react to soy) 6

• Hydrolyzed formulas (partially or extensively): Not recommended for prevention of food allergies in healthy infants 1

  • Lack of evidence that these prevent atopic disease even in high-risk infants 1
  • More expensive without proven benefit for prevention 2

• Specialty formulas marketed for "fussiness" or "colic": Empiric formula switching is not recommended without proper medical evaluation 6, 2

Special Medical Circumstances

Only switch from standard iron-fortified formula when there is a documented medical indication:

For Confirmed Cow's Milk Protein Allergy:

• First choice: Extensively hydrolyzed casein formula 6, 2
• Second choice: Elemental (amino acid-based) formula if extensively hydrolyzed formula is not tolerated 6

For Food Protein-Induced Enterocolitis Syndrome (FPIES):

• Elemental formulas are the best alternative 6
• Extensively hydrolyzed formulas may not be appropriate for all cases 6

For Infants with Intestinal Failure:

• Breast milk remains the first choice even in severe illness 1
• If unavailable, start with elemental formula in early infancy and severe illness, then switch to extensively hydrolyzed, then polymeric feeds as tolerated 1

Critical Timing Issues

Do not introduce whole cow's milk before 12 months of age 1, 3, 4

• Early introduction leads to iron deficiency anemia 3, 4
• Increases risk of cow's milk protein allergy 4
• Provides inadequate iron, linoleic acid, and vitamin E while providing excessive sodium, potassium, and protein 3

Monitoring Requirements

• Growth parameters (weight, length) should be monitored regularly in all infants, especially those on specialized formulas 6
• Vitamin D supplementation (400 IU daily) is required for all breastfed infants and those consuming less than 28 ounces of formula per day 1

Common Pitfalls to Avoid

• Do not switch formulas frequently based on normal infant fussiness or minor spit-up 6, 2
• Do not use hydrolyzed or soy formulas as a preventive measure without medical indication 1
• Do not delay iron-fortified formula in favor of low-iron options, as this leads to iron deficiency 1, 3
• Do not add supplements (DHA, ARA, prebiotics, probiotics) beyond what is already in standard formula, as evidence of benefit is insufficient 1, 2