Three Main Formula Categories

Postnatal, Your questions

To read the previous part, go to Infant Formulas .

Updated article : October, 2023.

There are three main categories of formulas:

  •   Cow milk protein-based formulas for everyday use for a healthy baby born at term;
  •   Soy-based milk used more in cases of galactosemia, lactose intolerance or vegan diets;
  •   Specialised formulas for premature or intolerant babies or babies with severe allergies. These formulas do not contain lactose.

Recently, “Certified Organic” formulas have entered the market. But for the moment nothing has proven that they have better nutritional value than other products. The final choice is up to parents. Organic or not, you always have to follow the manufacturer’s recommendations to minimize contamination, pesticides and undesirable substances. 

Bovine Protein-based Milk (Cow Milk)

Many companies offer these kinds of formulas, which are all produced similarly. What is the most difficult thing for a young baby to digest in these formulas? It’s the casein (protein) molecules in the formula, compared to the amount of whey. Whey, unlike casein, is much better absorbed, as it is in breast milk. Some formulas are presented in a more standard casein/whey ratio, while others are intended to be partially hydrolyzed, i.e. the protein has been deconstructed (usually 10 times smaller on average) and the casein has been eliminated. In these formulas, 100% whey is favored, which in the end facilitates digestion, promotes soft stools in babies, and leads to better gastric emptying.

Even if companies state that they have added miracle products to the formula, the quality of formulas on the market seems comparable, without being equivalent. However, you should not shift from one formula to another with a very young baby given the immaturity of their system, which has not yet adapted to their milk. 

Before suggesting specific milk for your baby, a health professional first needs to know a bit about their history since birth. Were they born at term? Do they have reflux? Do they have difficulty digesting even breast milk? Did they have colic earlier in their life? Were they constipated or did they have an anal fissure? Is there a family history of intolerance? Everything needs to be looked at before making a suggestion. For example, if the baby’s digestive system seems to be more fragile, we might suggest a milk that’s easier to digest right from the start, or even a formula that includes probiotics for a child with more colic, reflux or signs of constipation. If your baby was born at term, showed no reactions to breast milk and they are growing as expected, a cowmilk based formula will be suggested, and after 2-3 weeks of use, they will check to see if they react to it and will then make changes only as needed.

Soy-based Milk

Soybeans are a vegetable, so don’t have animal milk sugar (lactose) which, for some babies, causes discomfort. But soy-based milk should NEVER be given to babies unless recommended by a doctor. In fact, since you can also develop intolerance to soymilk, and there are also associated risks of nutritional deficiencies, you should get advice from an expert. Suggested for vegetarian diets or for cultural or religious reasons, and also in the case of galactosemia (carbohydrate metabolic disease). This milk can be continued up to the age of 2, if the baby does not consume cow’s milk after one year.

Therapeutic Milk

Therapeutic milk is much easier to digest if the baby’s system is immature or fragile. The bovine proteins can then be highly deconstructed, i.e., up to 50-60% of free amino acids (ex: Alimentum and Nutramigen) and there is also a recipe who exhibits complete decomposition at 100% acid free aminos (ex: Puramino and Neocate), which really helps the absorption in the baby’s intestine. All these specialized formulas are very low-lactose or lactose-free. If needed, the doctor can prescribe this kind of milk, for example, if your baby has clear signs of intolerance or severe allergies to regular formulas or in the presence of various syndromes. Beware of self-diagnosis, as in reality this milk is suitable for a minority of babies. This milk is costly, but in Quebec, you will be reimbursed for the full cost if the doctor filled out the form when prescribing it for a baby requiring only.

The above information is a good overview of the different formula categories, but there are dozens and dozens of different kinds of milk in each category. When in doubt, ask for help from a specialist. Perinatal health professionals can advise you about the best choice for your child. 

Transitional or second stage formulas refer to those products that are adapted for children over 6 months of age. When a child is eating well from a variety of food groups at 6 or 7 months of age, a parent can decide to give them second stage milk up to 9-12 months (even 18 months for a light drinker), which contains more calcium and iron to complement the solid foods the baby eats. He can also continue the first stage formula he is taking without any problem if he eats everything very well. At 9 months of age (for a full-term and healthy baby), a baby can drink 3.25% milk if they eat well and are growing and developing well. If your baby has had intolerances/ allergies younger or more important reflux or very important colic, it is better at this time to continue the formula until 1 year old,  before introducing 3.25% milk to give him every chance to mature even more his digestive system.

Pasteurized goat’s milk can also be presented to a baby from 9-12 months if he is healthy and he presents nothing special in terms of its development, but at the end, it does not offer more benefits to the baby than the 3.25%. 2% milk will not be recommended before the age of 2 years old, as well as soy, almond or rice drinks.

To learn more about formulas, read Types of Formulas.

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