Formulas
Overview
Formula Basics
- Ready to feed (does not need to be prepared with water)
- Powdered (must be mixed with water, but is the least expensive form)
- Concentrated liquid
|
Formulas are made of 6 basic components - protein, fat, carbohydrate, vitamins, minerals, and
other nutrients. Details about the components that make up formula can be found on the Portal at Formula Ingredients and Components. What makes formulas unique are the specific
carbohydrates, fats, and proteins used, as well as any additional ingredients added.
These differences
and their indicated use are explained below. International recommendations for formula composition can be found at [Koletzko: 2005]. Delivery of formula can involve use of a cup, spoon, supplemental nursing system, bottle, or feeding tube (see Feeding Tubes and Gastrostomies). The nutritional content of formula is regulated by the U.S. Food & Drug Administration based on recommendations by the Committee on Nutrition (AAP). Nutritional requirements, digestive concerns, metabolic demands, and the child's age drive the selection of one formula over another. Background information on the many types of formulas available and detailed information about the different components of formula and the rationale for their use are presented below. |
Formula for Term Infants
Age | Grams/Day |
---|---|
0-3 months | 25-30 |
3-6 months | 15-20 |
6-12 months | 10-15 |
Formula for Preterm and Low Birth Weight Babies
- Indications for use: Infants with low birth weight and preterm infants
- Examples: Similac Neosure Advance 22 kcal/oz, Enfamil Enfacare LIPIL 22 kcal/oz, Similac Special Care Advance 24 kcal/oz, Enfamil Premature LI PIL 24 kcal/oz
- Indications for use: Formulated for preterm infant specialized nutritional needs, which include increased protein, certain vitamins and minerals (such as calcium and phosphorus), and carbohydrates and fats designed to promote absorption (including a substantial portion of medium chain triglycerides). [Committee: 2013]
- Examples: Similac Neosure Advance 22 kcal/oz, Enfamil Enfacare LIPIL 22 kc al/oz, Similac Special Care Advance 24 kcal/oz, Enfamil Premature LI PIL 24 kcal/oz
- Indications for use: Formulated to improve metabolic outcomes in preterm infants whose primary long-term nutritional source is breast milk, to supply adequate protein, sodium, zinc, and to facilitate bone development. Liquid or powder formulations are added to breast milk. Human milk fortifiers may be found in the hospital setting; outside of the hospital setting, they typically require a prescription.
- Examples: Similac Human Milk Fortifier, Prolact Human Milk Fortifier, Enfamil Human Milk Fortifier
Formula for Older Children
Increasing Caloric Density - General Guide
Advise the caregiver to use precise measurements (e.g., a level scoop rather than rounded) to ensure consistent nutrition. Consult a dietician if unfamiliar with the nutritional and/or fluid requirements of your patient. If needed, contact a local NICU or children's hospital for advice. Cost and ease of home preparation must be considered.
Using Term Powder Formula to Increase Caloric Density
kcal/oz | Add one scoop of 20 kcal/oz powder formula to: |
---|---|
20 | 60 mL or 2 oz of water |
22 | 55 mL of water |
24 | 50 mL of water |
26 | 45 mL of water |
27 | 42 mL of water |
Using Preterm Powder Formula to Increase Caloric Density for Preterm Feeding Infants
kcal/oz | Add one scoop of 22 kcal/oz premature infant powder formula to: |
---|---|
22 | 60 mL or 2 oz of water |
24 | 55 mL of water |
26 | 50 mL of water |
27 | 48 mL of water |

+ Due to variations in formula composition, it is best to consult the manufacturer's website for more details. Powder is less accurate than liquid concentrates. [American: 2013]
Do-It-Yourself Formulas
Brands of Formulas
- Babies"R"Us
- Berkley Jensen (BJ's)
- Comforts for Baby (Kroger)
- CVS Health
- Kirkland Signature (Costco)
- Meijer (Meijer Baby)
- Member's Mark (Sam's Club)
- Parent's Choice (Walmart)
- Simply Right (Sam's Club)
- Up & Up (Target)
- Well Beginnings (Walgreens)
Pearls and Alerts
Preterm infant formula and human milk fortifiers are designed to meet the increased vitamin and mineral needs of the preterm infant consuming smaller volumes than the term infant. Continuation of preterm infant formulas and human milk fortifiers in infants who weigh more than 2.5-3.0 kg will result in increased intakes of several vitamins, including vitamins A and D. Case reports of hypervitaminosis D suggest that these products should be discontinued when the infant is exceeding the recommended intakes for fat-soluble vitamins.
Formula feeding contraindications
Contraindications include vomiting or spit-up associated with inadequate weight gain, colic, constipation or diarrhea, blood or mucus in stool, severe or difficult to treat eczema, hives, and anaphylaxis.
Aluminum toxicity
Preterm infants and infants that were intrauterine growth restricted who use soy formula may be at risk of aluminum toxicity. [Fanni: 2014]
Resources
Information & Support
Detailed information about differences in the basic components of formulas and the indicated use for the different formula types.
Formula Funding
Information about obtaining financial help with purchasing formulas for children with special health care needs.
For Professionals
Primary Prevention of Allergic Disease Through Nutritional Interventions: Guidelines for Healthcare Professionals (AAAAI)
( 181 KB)
Information about food introduction and prevention of allergies and atopic dermatitis; American Academy of Allergy Asthma
and Immunology.
Probiotics and Prebiotics in Pediatrics (AAP)
Reviews of the currently known health benefits of probiotic and prebiotic products, including those added to commercially
available infant formula and other food products for use in children; American Academy of Pediatrics.
For Parents and Patients
Support
Kids with Food Allergies (AAFA)
Provides education and an online support community for children with food allergies; a Division of the Asthma and Allergy
Foundation of America.
General
Nutrient Requirements for Formula (USGS)
A chart of infant formula nutrients based on the Code of Federal Regulations Title 21 Part 107; United States Federal Government.
Practice Guidelines
Fleischer DM, Spergel JM, Assa’ad AH, Pongracic JA.
Primary Prevention of Allergic Disease Through Nutritional Interventions: Guidelines for Healthcare Professionals.
American Academy of Allergy Asthma & Immunology.
1:29-36; 2013.
/ http://medical.gerber.com/docs/default-source/pdfs/aaaai-physician-ref...
Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer
SH, Simon RA, Vickery BP, Wood R, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph
C, Schuller D, Spector S, Tilles SA, Wallace D, Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn
A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R.
Food allergy: a practice parameter update-2014.
J Allergy Clin Immunol.
2014;134(5):1016-25.e43.
PubMed abstract
Patient Education
Let's Talk about Infant Formula Basics (Intermountain Healthcare) ( 392 KB)
A printable patient handout that explains formula selection, preparation, and storage.
Let's Talk about Infant Formula Basics (Spanish) (Intermountain Healthcare) ( 163 KB)
A printable patient handout in Spanish that explains formula selection, preparation, and storage.
Tools
Fluid Calculator for Children (Medscape)
Calculates typical daily and hourly fluid requirements (mL) per weight of the child.
Formulas and Fortifiers for Premature and Low Birth Weight Infants ( 94 KB)
A chart that lists the major brands of formula and the key differences among their ingredients; created by the Medical Home
Portal.
Formulas for Metabolic Conditions ( 138 KB)
A chart that lists the major brands of formula and the key differences among their ingredients.
Formulas for Term Infants ( 265 KB)
A chart that lists the major brands of formula and the key differences among their ingredients; created by the Medical Home
Portal.
Formulas for Toddlers & Older Children ( 296 KB)
A chart that lists the major brands of formula and the key differences among their ingredients; created by the Medical Home
Portal.
Nutrition Issues and Concerns (Bright Futures) ( 1.8 MB)
Detailed guidance on breastfeeding and nutritional issues for children with special health care needs. A table with energy
calculations for children and adolescents with Down syndrome, spina bifida, Prader-Willi syndrome, cystic fibrosis, and pediatric
HIV infection is on page 125; American Academy of Pediatrics.
Services in Idaho
Developmental Pediatrics
We currently have no Developmental Pediatrics service providers listed; search our Services database for related services.
Nutrition Assessment Services
See all Nutrition Assessment Services services providers (104) in our database.
Pediatric Gastroenterology
See all Pediatric Gastroenterology services providers (2) in our database.
For other services related to this condition, browse our Services categories or search our database.
Helpful Articles
Hojsak I, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler Mis N, Hulst J, Indrio F, Lapillonne A, Mølgaard C, Vora R,
Fewtrell M.
Young Child Formula: A Position Paper by the ESPGHAN Committee on Nutrition.
J Pediatr Gastroenterol Nutr.
2018;66(1):177-185.
PubMed abstract
Martin CR, Ling PR, Blackburn GL.
Review of Infant Feeding: Key Features of Breast Milk and Infant Formula.
Nutrients.
2016;8(5).
PubMed abstract / Full Text
Molska A, Gutowska I, Baranowska-Bosiacka I, Noceń I, Chlubek D.
The content of elements in infant formulas and drinks against mineral requirements of children.
Biol Trace Elem Res.
2014;158(3):422-7.
PubMed abstract / Full Text
Chung CS, Yamini S, Trumbo PR.
FDA's health claim review: whey-protein partially hydrolyzed infant formula and atopic dermatitis.
Pediatrics.
2012;130(2):e408-14.
PubMed abstract
Jatinder Bhatia, MD, Frank Greer, MD.
Use of Soy Protein-Based Formulas in Infant Feeding.
Pediatrics.
2008;121(5).
PubMed abstract / Full Text
Koletzko B, Baker S, Cleghorn G, Neto UF, Gopalan S, Hernell O, Hock QS, Jirapinyo P, Lonnerdal B, Pencharz P, Pzyrembel H,
Ramirez-Mayans J, Shamir R, Turck D, Yamashiro Y, Zong-Yi D.
Global standard for the composition of infant formula: recommendations of an ESPGHAN coordinated international expert group.
J Pediatr Gastroenterol Nutr.
2005;41(5):584-99.
PubMed abstract
Kumar M, Kabra NS, Paes B.
Carnitine supplementation for preterm infants with recurrent apnea.
Cochrane Database Syst Rev.
2004(4):CD004497.
PubMed abstract
Laili Abd Latif, M et al.
Nutrition Interventions for Children with Special Health Care Needs.
2010; 3rd:441. Washington: Washington Department of State Health; https://www.doh.wa.gov/Portals/1/Documents/8100/961-158-CSHCN-NI-en-L....
National Institutes of Health.
Infant Formulas.
U.S. National Library of Medicine; (2015)
http://www.nlm.nih.gov/medlineplus/ency/article/002447.htm. Accessed on August 2018.
Singhal A, Kennedy K, Lanigan J, Clough H, Jenkins W, Elias-Jones A, Stephenson T, Dudek P, Lucas A.
Dietary nucleotides and early growth in formula-fed infants: a randomized controlled trial.
Pediatrics.
2010;126(4):e946-53.
PubMed abstract
Verner A, Craig S, McGuire W.
Effect of taurine supplementation on growth and development in preterm or low birth weight infants.
Cochrane Database Syst Rev.
2007(4):CD006072.
PubMed abstract
Page Bibliography
Abrams SA.
Is it time to put a moratorium on new infant formulas that are not adequately investigated?.
J Pediatr.
2015;166(3):756-60.
PubMed abstract
American Academy of Pediatrics Committee on Nutrition; Editor in chief: Ronald E. Kleinman, MD, FAAP; Associate editor: Frank
R. Greer, MD, FAAP .
Pediatric Nutrition.
7th ed. Elk Grove Village. IL: American Academy of Pediatrics;
2013.
978-1-58110-816-3 http://shop.aap.org/Pediatric-Nutrition-7th-Edition-Paperback/
Belamarich PF, Bochner RE, Racine AD.
A Critical Review of the Marketing Claims of Infant Formula Products in the United States.
Clin Pediatr (Phila).
2015.
PubMed abstract
Committee on Nutrition; Editor in chief: Ronald E. Kleinman, MD, FAAP; Associate editor: Frank R. Greer, MD, FAAP .
Pediatric Nutrition.
7th Edition ed. Elk Grove Village, IL: American Academy of Pediatrics ;
2013.
978-1-58110-816-3 http://shop.aap.org/Pediatric-Nutrition-7th-Edition-Paperback/
Fanni D, Ambu R, Gerosa C, Nemolato S, Iacovidou N, Van Eyken P, Fanos V, Zaffanello M, Faa G.
Aluminum exposure and toxicity in neonates: a practical guide to halt aluminum overload in the prenatal and perinatal periods.
World J Pediatr.
2014;10(2):101-7.
PubMed abstract
Koletzko B, Baker S, Cleghorn G, Neto UF, Gopalan S, Hernell O, Hock QS, Jirapinyo P, Lonnerdal B, Pencharz P, Pzyrembel H,
Ramirez-Mayans J, Shamir R, Turck D, Yamashiro Y, Zong-Yi D.
Global standard for the composition of infant formula: recommendations of an ESPGHAN coordinated international expert group.
J Pediatr Gastroenterol Nutr.
2005;41(5):584-99.
PubMed abstract
Laili Abd Latif, M et al.
Nutrition Interventions for Children with Special Health Care Needs.
2010; 3rd:441. Washington: Washington Department of State Health; https://www.doh.wa.gov/Portals/1/Documents/8100/961-158-CSHCN-NI-en-L....
National Institutes of Health.
Infant Formulas.
U.S. National Library of Medicine; (2015)
http://www.nlm.nih.gov/medlineplus/ency/article/002447.htm. Accessed on August 2018.
Sung V, D'Amico F, Cabana MD, Chau K, Koren G, Savino F, Szajewska H, Deshpande G, Dupont C, Indrio F, Mentula S, Partty A,
Tancredi D.
Lactobacillus reuteri to Treat Infant Colic: A Meta-analysis.
Pediatrics.
2018;141(1).
PubMed abstract
Thomas DW, Greer FR.
Probiotics and prebiotics in pediatrics.
Pediatrics.
2010;126(6):1217-31.
PubMed abstract / Full Text