Regular cow's milk-based infant formula

Should I use regular cow’s milk-based infant formula?

Regular infant formula based on cow’s milk is the most common type for healthy, full-term babies. If your baby needs infant formula, start with this unless your health-care providers say otherwise. Another kind of regular infant formula is partially hydrolyzed. In this, some of the larger protein molecules are broken down. It has a limited role but may help some babies with constipation. There is little evidence it prevents allergies, despite claims. Reduced-lactose and lactose-free infant formulas also contain cow’s milk protein, but some or most of the lactose is replaced by another sugar. There are very few situations in which this type of infant formula is useful. There are also organic infant formulas, but there is very little documented health benefit to using them.

A) Describing regular cow’s milk-based infant formula

Regular infant formula (formula) based on cow’s milk is the most common type of formula given to healthy, full-term babies. If your baby needs formula, start with this type unless your health-care providers say otherwise.

The protein in this formula is based on cow’s milk and the sugars may include lactose (milk sugar), corn syrup solids, and maltodextrin. The types of oils also vary. Ensure that any formula you use is “iron-fortified.”

Regular infant formula can also be based on goat's milk. 

B) Partially hydrolyzed infant formula

Partially hydrolyzed formula is another kind of regular formula based on cow’s milk, but some of the larger protein molecules have been broken down (hydrolyzed) into smaller pieces.

Partially hydrolyzed formula has a limited role. It may help some babies with constipation because of formula use (Borschel 2014; Vandenplas 2014).

While it contains smaller amounts of big proteins, it still contains enough protein to cause reactions in children. It is not meant for children with cow’s milk protein allergies. They will react to the protein.

While partially hydrolyzed formula has been promoted as preventing allergies, there is little evidence it prevents allergies or the allergic diseases, asthma and eczema (Chung 2012; Szajewska 2017; Vandenplas 2018). One study showed babies given partially hydrolyzed formula had an increased risk of allergic diseases at 8 years of age (Amazouz 2020).

It has also been promoted as easier to digest, but this has not been supported by research (Berseth 2009).

Partially hydrolyzed formula is often more expensive than regular formula.

C) Lactose-reduced infant formula

Lactose is the main sugar in breast milk, cow’s milk, and many formulas. Lactose-reduced and lactose-free formula contain cow’s milk protein, but some or nearly all of the lactose has been replaced by another sugar such as corn syrup solids or brown rice syrup. 

Both lactose-reduced and lactose-free infant formula are often marketed as decreasing tummy gas and crying. There is very little evidence to support this. Indeed, there are very few conditions in which babies cannot tolerate lactose.

There may be drawbacks to using lactose-reduced and lactose-free formula.

D) Organic infant formulas

There appear to be differences between organic and non-organic formula components (Meoni 2020). However, there is no documented health benefit to using organic formula and no difference in hormone levels in babies (Green Corkins 2016).

Organic formula is generally more expensive than non-organic. 

References

Amazouz H, de Lauzon-Guillain B, Bourgoin-Heck M, et al. Infant feeding clusters are associated with respiratory health and allergy at school age in the PARIS birth cohort. Allergy. 2020 Aug 20

Berseth CL, Mitmesser SH, Ziegler EE, et al. Tolerance of a standard intact protein formula versus a partially hydrolyzed formula in healthy, term infants. Nutrition Journal. 2009;8:27
 
Borschel MW, Choe YS, Kajzer JA. Growth of healthy term infants fed partially hydrolyzed whey-based infant formula: a randomized, blinded, controlled trial. Clin Pediatr (Phila). 2014 Dec;53(14):1375-82
 
Chung CS, Yamini S, Trumbo PR. FDA's health claim review: whey-protein partially hydrolyzed infant formula and atopic dermatitis. Pediatrics. 2012 Aug;130(2):e408-14
 
Green Corkins K, Shurley T. What's in the Bottle? A Review of Infant Formulas. Nutr Clin Pract. 2016 Dec;31(6):723-729

Meoni G, Tenori L, Luchinat C. Nuclear Magnetic Resonance-Based Metabolomic Comparison of Breast Milk and Organic and Traditional Formula Milk Brands for Infants and Toddlers [published online ahead of print, 2020 Jun 9]. OMICS. 2020;10.1089/omi.2019.0125 

Szajewska H, Horvath A. A partially hydrolyzed 100% whey formula and the risk of eczema and any allergy: an updated meta-analysis. The World Allergy Organization Journal. 2017;10(1):27
 
Vandenplas Y, Cruchet S, Faure C, et al. When should we use partially hydrolysed formulae for frequent gastrointestinal symptoms and allergy prevention? Acta Paediatr. 2014 Jul;103(7):689-95
 
Vandenplas Y, Latiff AHA, Fleischer DM, et al. Partially hydrolyzed formula in non-exclusively breastfed infants: A systematic review and expert consensus. Nutrition. 2018 Jun 20;57:268-274