If you’ve never cared for a formula-fed baby, it’s hard to imagine how essential a commodity like infant formula can be. Other than breast milk, formula is the only thing a small baby can eat — hence parents’ panic last year during the height of the formula shortage, when stores shelves across the country were empty.
Formula is also one of the biggest expenses in a baby’s first year, adding up to thousands of dollars in those 12 months. (The Centers for Disease Control and Prevention advises waiting until a child turns 1 year old to introduce cow’s milk or non-dairy milk.) To save money, parents may try to buy formula in bulk, or look to lower-cost generic formulas instead of name brands.
At the same time, parents may worry that less expensive formulas aren’t as good for their babies. They may also hear that infant formulas sold in Europe are “cleaner” and superior to the ones sold in the U.S., and wonder if they should be purchasing this staple from abroad, or looking for U.S. equivalents.
In addition to the significant expense, this all adds up to a lot of added stress for parents as they manage the many other challenges of their child’s first year.
So, what’s the scoop on formula? Are more expensive or European brands actually better for babies?
What’s in formula?
Here in the U.S., the Food and Drug Administration heavily regulates the ingredients in what can be marketed and sold as infant formula.
“Many parents don’t know that infant formula is the single most highly regulated food product in the country,” Mallory Whitmore, known on Instagram as The Formula Mom, told HuffPost. This makes sense, she added, as “infants are inherently vulnerable and have very specific nutrient needs in the first year of life.”
In order to market a product as “infant formula” manufacturers must: include minimum levels of 29 nutrients, and no more than a maximum level for nine of those nutrients; provide proof, such as a clinical trial, that any never-before-used ingredients are safe; and produce their formula in an FDA-approved, regularly inspected facility.
Lisa Richardson, a registered dietitian and the founder of Formula Sense, told HuffPost that even the labels on cans of formula are regulated, “which is why all formulas have pictures of how to make formula and similar language.”
She continued: “Companies manufacturing or distributing formula in the United States must be registered with the FDA. New infant formulas must undergo a review process before being sold.”
Do less-expensive formulas have inferior nutrition?
As explained in the Q&A on the FDA website, “All infant formulas marketed in the United States must meet the nutrient specifications listed in FDA regulations.” Because of this, “all infant formulas on the market are safe and nutritionally complete for infants 0-1,” said Whitmore, who works with the formula brand Bobbie.
In other words, all infant formulas — including generic brands — have the same balance of proteins, fats and carbohydrates.
All of the generic brands, or retail store brands, such as Walmart, Target, Sam’s Club, Amazon and Kroger, are, in fact, made by the same company: Perrigo.
“No matter which store brand you buy, what’s inside the can is the same,” said Richardson. “Store brand formulas are mimics of familiar big-name formula brands,” meaning the differences between them are minimal.
There are, Richardson said, some newer “formula ingredient innovations like whole fat milk or specialty proteins” that are found in the higher-cost formulas, but nutritional profiles across different formulas are essentially the same.
The exception is hypoallergenic formulas, often “marketed as sensitive, comfort, tender, or gentle,” according to Richardson. These are for babies who have trouble digesting regular formula, and you should discuss using them with your pediatrician.
What’s the deal with European formula?
Just as in the U.S., the government of the European Union (which oversees 27 European nations) regulates what can be marketed and sold as infant formula there.
“European formulas are regulated by a government regulatory body similar to the FDA. They simply have different requirements for nutrient content,” said Dr. Janine Zee-Cheng, a pediatrician practicing in Indiana.
Because, as Richardson describes, “EU infant formula requirements severely limit pesticide residues in products intended for infants and young children,” European formulas are sometimes considered “cleaner” than those made in the U.S., where, Richardson said, there are “no regulations on pesticides specific to infant formula.” This is consistent with pesticide limits on other products, which are stricter in the EU than in the U.S.
(Because we are all exposed to pesticides, even breastfeeding doesn’t completely prevent their transmission. They are found, along with other toxins and pollutants, in human milk.)
There are a few other ways European formula differs from formula sold in the U.S. European formula is marked as either stage 1, for infants up to 6 months old, or stage 2, for infants 6-12 months. (Stage 1 has more whey protein, which is thought to be easier to digest. The National Health Service in the U.K. explains that babies can drink stage 1 formulas until they turn 1, or they can switch to stage 2 formulas, which have a different mix of proteins, at 6 months of age.) In the U.S., all formulas are marketed for use in babies from birth to 12 months.
Second, U.S. formulas require a higher iron content, 50%-80% higher than that found in EU formulas, according to Richardson. This is worth noting, because iron can change the look of your baby’s diaper, making stools darker or greener. The American Academy of Pediatrics recommends a higher daily iron intake than similar physician groups in the EU in order to prevent iron-deficiency anemia. Nutrient requirements for formula are given as a range, and there is overlap between the U.S. and EU iron requirements.
Finally, formulas sold in the EU are not allowed to contain corn syrup or corn syrup solids (they contain other sugars, like lactose), whereas no such prohibition exists in the U.S. Formulas in the EU are also required to contain DHA, an omega-3 fatty acid. It is commonly marketed to both children and adults in fish oil supplements, as it occurs naturally in fatty fish like cod and salmon.
Zee-Cheng advises that families take precautions if ordering formula from abroad: “Use a reputable retailer, make sure that the can is unopened, that the label looks genuine, etc. Counterfeit formula does exist. Additionally, temperature during shipment makes a difference, as does exposure to the elements.”
There are U.S.-produced formulas that mimic EU brands in terms of organic ingredients (look for the U.S. Department of Agriculture organic label), absence of corn syrup, and the inclusion of DHA. They are more expensive than other brands.
“What differs between formulas, and often accounts for cost, is the ingredients used to source these nutrients,” said Whitmore. She used carbohydrates as an example. Both corn syrup and lactose (a sugar found in cow’s milk and human milk) can provide the amount of carbohydrates an infant needs to grow. “Lactose, however, is more expensive to use and is a bit trickier to manufacture (it’s sticky!), and this can increase the cost of the final formula product,” she explained.
Parents who themselves eat organic foods and avoid ingredients like corn syrup and palm oil may feel more comfortable using an infant formula that aligns with these preferences, but any brand of infant formula will provide all the nutrients a baby needs to grow healthily.
What else do formula-feeding parents need to know?
Richardson recommends comparing unit prices, such as cost per ounce, rather than cost per can of formula, as different brands are sold in different quantities.
“Variation in formula can sizes make it hard to compare cost between brands,” she said. Divide the cost per can by the amount of formula in the can to get the unit cost. For example, currently on Target.com, Bobbie formula is $25.99 for a 14-ounce can ($1.86 per ounce) and the store’s own Up & Up brand — the one made by Perrigo — is $24.49 for a 35-ounce can ($0.70 per ounce).
“My other favorite piece of advice for the healthy baby related to cost is that it is OK to change formulas,” said Richardson.
“Human milk changes from day to day,” she continued. “Babies are born to experience flavor and nutritional variety. Go ahead and buy the formula that is on sale.”
Zee-Cheng said she recommends families use a formula “that is relatively easy to obtain ... within their budget; and that they can mix/use correctly every time.”
If parents are feeling guilty about using formula, or not using the more expensive formula, they should go easy on themselves, said Richardson: “Research has shown again and again and again that infants grow and thrive on formula. When you remember that the nutrition bar is already set high, you aren’t comparing broccoli to a cupcake. You are comparing broccoli to cabbage or to kale.”
Whitmore agrees with this sentiment. “There is no bad formula and there’s no best formula — it simply comes down to what’s important to you and what works for your family,” she said.