Infant Feeding Options
Parents and caregivers are encouraged to contact their healthcare provider or pediatrician before their baby is born to determine which infant feeding options work best for their particular circumstances.
Breastfeeding is the preferred and recommended first choice for infant feeding. For infants who are not exclusively fed breast milk, commercial infant formula is the only safe, science supported, nutritious and recommended nourishment.
According to a recent survey commissioned by the Infant Nutrition Council of America, nearly 50% of moms who breastfed for up to six months also fed formula to their baby. Parents and caregivers who choose to supplement breast milk with infant formula make this decision for a variety of reasons: they may be returning to work and not have the time or place to pump; they may be having problems breastfeeding or not producing enough milk for baby’s appetite; or they want to give others an opportunity to participate in infant feeding. Parents or caregivers considering introducing formula into their infant’s diet should consult their pediatrician.
The (FDA) recommends against feeding breast milk acquired directly from individuals or through the Internet because of possible health and safety risks. If parents and caregivers are having trouble breastfeeding or are interested in donor breast milk, they should speak with a lactation consultant, their pediatrician or healthcare provider.
Infant formula can be safely purchased from reputable retailers, either in their brick and mortar stores or through their official website.
Purchasing infant formula from individuals, such as at flea markets, on e-commerce websites or on internet auction sites, is not recommended. These products may have been improperly stored or shipped, which can negatively affect the quality of the formula. Parents and caregivers should be sure to always look for any punctures, dents or potential tampering, and check the use by date on each container of formula before purchasing.
Cereal should not be added to a baby’s bottle. Babies younger than six months of age typically do not need to consume complementary foods such as cereals. However, between the ages of four and six months, parents and caregivers may notice their baby starting to become curious about other foods or giving clues that they want complementary foods in addition to breast milk and/or formula. Some of the clues parents and caregivers might notice are their baby watching what they eat or reaching for their food.
As their baby develops this interest, they should also check including being able to hold their head up, open their mouth when they see food and being able to move food to swallow it. According to the , “a baby’s digestive system is not thought to be well prepared to process cereal until about 6 months of age.” They also recommend waiting to give babies solid foods until they weigh at least 13 pounds. Once a baby shows signs that they are ready to eat solid food, parents and caregivers should discuss the best ways to introduce spoon-feeding for their baby with their pediatrician.
The transition from breast milk or infant formula to solid foods should be gradual so parents and caregivers will need to continue giving their baby breast milk or infant formula as they introduce solid foods. Nutrient levels in solid baby foods, either commercially prepared or homemade, vary considerably.
Because of this, it is important parents and caregivers continue to provide breast milk or infant formula during the gradual transition to solid foods as they still contribute substantially towards an infant’s total nutrient requirements. The Committee on Nutrition of the recommends exclusive breastfeeding for about six months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for one year or longer as mutually desired by mother and infant.
According to the Committee on Nutrition of the American Academy of Pediatrics (AAP), cow’s milk (e.g., whole, 2%, 1%, 1/2% or skim) is not appropriate for children under the age of one year because they cannot digest cow’s milk as easily as breast milk or infant formula.
Additionally, iron deficiency anemia is the most common nutritional problem in infants, and cow’s milk does not provide a sufficient amount of iron to meet a baby’s needs. 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, which leads to iron being lost in the blood. Additionally, cow’s milk contains higher levels of protein and sodium than recommended for infants, as well as lower levels of vitamin C, vitamin E and copper. Cow’s milk also contains butterfat that may be difficult for a baby to digest.
For these reasons, AAP’s Committee on Nutrition recommends infants be breastfed or provided iron-fortified infant formula during the first year of life in addition to the introduction of appropriate complementary foods around six months.
The U.S. Food and Drug Administration (FDA) strongly recommends against making and feeding homemade infant formula. Parents and caregivers may incorrectly believe making their child’s infant formula is safe and nutritious. However, feeding homemade formula could lead to very serious short and long-term health consequences.
There is evidence that homemade infant formulas, which can contain raw, unpasteurized cow, goat, or sheep milk, can lead to bacterial infections, especially in infants. Additionally, homemade infant formula may lack appropriate levels of nutrients needed to support healthy infant growth.
Commercial infant formulas are the most highly regulated food, and are carefully quality-controlled and manufactured to the highest industry and government standards. To read more INCA resources on homemade infant formula, please visit:
Types of Infant Formula
Infant formula is available in three types: ready-to-feed liquid, concentrated liquid and powder.
- Ready-to-feed liquid formulas are used as-is. Ready-to-feed is the most expensive, but is very convenient as it requires no mixing or measuring. This type of formula may be recommended when safe water is not readily accessible.
- Concentrated liquid formulas require mixing with water according to the instructions on the container.
- Powdered formulas must be reconstituted with water according to the instructions on to the container. Powdered formula is least costly, but it is not a sterile product so parents and caregivers should closely follow the preparation instructions when preparing bottles.
Parents and caregivers should contact their pediatrician to select an appropriate formula for their baby.
All commercial infant formulas provide babies with the nutrients he or she needs. Cow’s milk-based infant formulas are the most common and tolerated well by most babies.
Some babies are sensitive to or don’t tolerate cow’s milk-based formulas well. If a baby does not tolerate lactose (the sugar found in milk), has a milk sensitivity or allergy, or if a parent or caregiver wants their infant to have a vegetarian-based diet, they may want to consider soy protein-based formulas.
Some babies are sensitive to milk and soy-based formulas. For extremely sensitive babies, there are formulas that contain predigested or hydrolyzed proteins which may be easier to digest.
Even though babies often grow out of their allergies and food sensitivities, it’s important to remember that a baby with one allergy is more likely to have additional food allergies later in life. If a baby has food allergies, parents or caregivers should discuss introducing new foods and proteins into their baby’s diet with their pediatrician. Click for additional INCA resources on formulas for babies with allergies.
Infant Formula Composition
U.S. infant formulas are required by law to contain 29 essential nutrients to ensure they support healthy infant growth. Infant formulas contain protein, carbohydrates and fat, which provide the calories necessary to maintain bodily functions, support physical activity and promote growth, while supporting desirable immune functions needed for overall nutrition and development. Protein also provides the necessary components to build and repair the body’s tissues. 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.
U.S. infant formulas also contain docosahexanoic acid (DHA) and arachidonic acid (ARA), two nutritional fatty acids that are found in breast milk and which are considered “building blocks” for the development of brain and eye tissue. DHA and ARA are added to infant formulas based on the levels present in breast milk. This practice is supported by many government and non-governmental health organizations worldwide.
Infant formulas contain extremely low levels of fluoride. While fluoride helps protect against tooth decay and cavities, too much fluoride in a child’s diet can result in enamel fluorosis, a non-medical and strictly cosmetic issue that does not affect the strength or function of the teeth. The American Dental Association (ADA) recommends that parents who wish to reduce their infant’s exposure to fluoride use ready-to-feed liquid infant formula or use fluoride-free or bottled water to prepare powdered and concentrated liquid infant formula. A physician may recommend fluoride supplementation for infants who are at least six months of age who are at high risk of deficiency.
Bottle Preparation, Storage and Handling
Infant formula manufacturers recommend against preparing powdered infant formula with boiling hot water (i.e., 70° Celsius/ 158° F). This recommendation is supported by the U.S. Food and Drug Administration (FDA) and the Academy of Nutrition and Dietetics. Reconstituting powdered formula with very hot water may result in nutrient degradation (e.g., deterioration of water soluble vitamins) and physical stability problems (e.g., clumping or separation), and could result in scalding of the caregiver and infant. If sterilized water is preferred for mixing, parents and caregivers should boil the water and let it sit for at least 30 minutes to cool, but no more than four hours, before mixing it with infant formula.
To read additional INCA resources on preparing infant formula, please visit:
All infant formulas have a “use by” date on the container. Formula should not be bought or fed beyond this date, as some nutrient levels may decrease and there may be changes in physical properties, such as discoloration and separation of fat. Infant formula companies have a reimbursement program for outdated products, as well as policies that encourage stores not to sell products past their use by date. Some states have also passed laws prohibiting stores from selling outdated products, including expired formula.
If a parent or caregiver’s formula is out-of-date at the time of purchase, they should return it to the store from which it was purchased for exchange or reimbursement or contact the manufacturer directly.
Parents should follow these guidelines when storing mom’s breast milk:
- Freshly Pumped Milk – Freshly expressed milk can safely sit at room temperature for 3-4 hours, then should be refrigerated or frozen.
- Refrigerated – Breast milk can remain safe in the refrigerator for about 3-5 days, according to the American Academy of Pediatrics.
- Frozen – Frozen breast milk can be stored at 0° F for 6-12 months.
- Thawed – Breast milk should be thawed in the refrigerator, and fed within 24 hours. Click here for additional INCA resources on storing breast milk.
- Powdered – A prepared bottle of powdered infant formula that has been refrigerated should be used within 24 hours; follow instructions on the label. Prepared formula that has been in room temperature should be used within one hour. The remaining powdered infant formula should be tightly covered, stored in a cool, dry place and used within a month after opening.
- Liquid Concentrate – An open can of liquid concentrate infant formula is safe to use for up to 48 hours. The remaining formula should be tightly sealed and placed in the refrigerator immediately after opening.
- Ready-to-feed Liquid – Ready-to-feed infant formula should be fed within two hours after preparing a bottle. Any formula not used to prepare a bottle should be refrigerated immediately and used within 48 hours.
Parents should pay close attention to expiration dates on their baby’s infant formula and refer to specific instructions provided on the infant formula label.
Freezing infant formula is not recommended. Though freezing does not affect the safety or quality of the formula, separation of the product’s components (e.g., fats, proteins) can occur when the formula is thawed. This may result in a baby receiving fewer nutrients. Also, the flow of milk through the bottle’s nipple may be slower, making it harder for a baby to suck.
Reheating breast milk or reheating infant formula from a previous feeding is unsafe for a baby.
Microorganisms from the baby’s mouth are introduced into the milk during feeding, and multiply over time. Even a few hours can mean microorganisms have multiplied enough to become a safety concern. Neither refrigeration nor reheating will prevent this growth so putting the bottle in the refrigerator and reheating it is not safe.
Discard any formula or breast milk that is not consumed during feeding.
Microwave ovens should NEVER be used for heating infant formula or breast milk. Microwaves heat food and bottles unevenly, which can result in hot spots that can seriously injure a baby. So when warming a bottle, parents and caregivers should use a bottle warmer or place the bottle in a saucepan of heated water. Room temperature and cold bottles of prepared formula are also okay for baby to drink, depending on a baby’s preference.
To read more INCA resources on breast milk and infant formula feeding preparation, please visit: