Categories: Ask Dr. Lanny
      Date: Jan  1, 2010
     Title: A Formula for Success

Breast is best, but artificial milk isn’t so bad either

By DR. Alan Freshman

WARNING: This column is loaded with discussion about baby formula … and it’s not all bad!

© Constantin Opris |

WARNING: This column is loaded with discussion about baby formula … and it’s not all bad!

As with all other pediatricians, I absolutely recommend that mothers breastfeed their newborn for the first year of life. There can be no doubt that this is the single most important thing moms can do for their children’s good health. Whether from a nutritional, immunologic, anti-allergic or emotional point of view, breast milk is the “right stuff” for the babies of all who can nurse. While there are mothers who are taking medications that are incompatible with nursing, or who are incapable of nursing, such cases are exceedingly few and far between. If you are in good health and you want to nurse, almost certainly you can.

Nevertheless, there are many, many good and concerned mothers who will choose formula from the beginning, or who will switch to formula at some point in the first year of life. Although infant formula is not the equivalent of breast milk, its use will still lead to a growing and healthy baby.

Is there a best infant formula?
Clearly this is the most important question, and of course one that has no easy answer. If you go to a well-stocked supermarket, or “big-box” retailer you will find a profusion of major names (Similac, Enfamil) as well as store brands (Wegmans, Wal-Mart). Each and every brand will then have several sub-products: gentle, soy, added rice, hypoallergenic and more.

Even if we compare apples to apples—let’s say a typical cow milk-based product like Enfamil Lipil to its competitors, judging what is best is not clear. If you bring a magnifying glass to the formula aisle and carefully read the ingredients, the calories and the percent provided of various daily requirements, you’ll find that the formulas are remarkably similar. This similarity is because infant formula is regulated by the Food and Drug Administration, and all formula sold in the United States must adhere to strict nutritional standards. (You say you don’t totally trust the FDA. I understand skepticism of mainstream authority, but I don’t see any better resource out there, and I certainly would take Web sites that have “the truth” with huge grains of salt.)

Although each infant formula company will tout its brand as most similar to breast milk, with additives that are best for the brain or the eyes, there really are no head-to-head, long-term studies to prove those claims. In the not-so-distant past, parents made their own formula out of condensed milk and Karo syrup. Can you imagine that? And yet their babies thrived, and even went on to become doctors.

What about price?
My children, Lucas and Daniel, are decades beyond breast or formula, so I went on a field trip to Price Chopper, Wal-Mart and Wegmans to research formula prices. My first observation was: Why would you ever use formula instead of breast milk given the prices? As is often the case with commercial products, container sizes may be similar, but not identical, making comparisons more difficult. Even within the same brand, for example Parent’s Choice, prices for different sub-products vary by 10 percent per unit. Store brands are generally cheaper than their brand-name competitors, but this is not always the case.

Should you use ready-to-feed, liquid concentrate or powder? What’s the difference among these three types? It is simply a question of who adds the water. You do with the powder form. You and the formula company each add some with the liquid concentrate, and the company adds it all with ready-to-feed formula. Nutritionally it is all the same. Most mothers find powder the most convenient.

Should you use bottled water? Tap water? If we are talking Onondaga County, this one is easy. Onondaga County water is clear and clean. Use it straight from the tap without boiling. Bottled water is unnecessary, creates additional plastic in our environment, and takes energy to make and/or schlep from Maine or France or wherever. Yes, there is fluoride in our water supply, but at long established levels that are safe and have made dental decay nearly nonexistent. Sterilizing bottles seems like a wise idea, but the reality is that soap, water and a normal child are all that is necessary.

What about bottles?
Recently there has been increasing concern about the safety of the compound BPA found in baby bottles, cans and beverage containers. The FDA maintains that no danger has been confirmed, but it also says that if you are concerned, use a bottle that doesn’t contain BPA. Given that non-BPA plastic bottles and glass bottles are readily available, this seems an easily avoided concern.

I’m sure you can think of other formula-elated questions, and I’d be pleased to try and answer any more anyone cares to send me.                                 

Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at