Tips for choosing an infant formula from NICU RNs

January 15, 2020November 12, 202316min read

Whether you start your baby on formula day one, supplement to extend breastfeeding, or transition to it once you’re done weaning, it doesn’t matter! Keep reading below for the answers to ALL of your questions on how to choose an infant formula and everything you’ll need to know about infant formula.

I’m a firm believer in feeding your baby in a way that works for your family and the baby

Did you know that Dr. Young from @BabyFormulaExpert has a “How to Choose Confidently Choose a Formula for Your Unique Angel” course? It goes over everything – ingredients and how to choose the right formula (think gassiness, milk intolerance, digestive issues – maybe you need to make a change!). Click here and use code BUMBLE for discount.

One of my favorite formulas that has a protein ratio closest to breastmilk is Bobbie Formula (use code BUMBLEBABY10 for discount). Read all our posts on Bobbie and comparisons with other popular formulas.

Check out Bobbie infant formula here. PS – they just launched a GENTLE formula!

*Bobbie baby formula is a cow’s milk based infant formula and may not be suitable for all infants. Always speak with your provider if you have any concerns about your baby’s health and/or before making any change or addition to your baby’s diet.

how to choose an infant formula

Formula guidelines**follow the guidelines on your can!

When can I introduce formula?

Formula can be introduced at any time. Some decide to supplement from the beginning or to solely formula feed. If you have been breastfeeding or pumping and feeding pumped milk, you can introduce formula at any time. Some examples would be:

Adding formula to breastmilk bottles (combination bottles)
Offering formula after breastfeeding
Offering some feeds of all breastmilk and some feeds of all formula
Replacing one pump/feed a day with formula and storing breastmilk

What formulas do you recommend?

Gah. This is such a complicated question!

YOU have to decide what’s important to you in a formula:

Cost
Convenience
Organic
European vs. American
If you are using formula as a supplement or as a main food source
Your baby’s specific needs, such as prematurity, reflux, allergies

For me, convenience was key, so European formulas were out the window. Organic was important to me. I was supplementing minimally, so cost wasn’t as much of a factor. Finn did not have any specific needs in regard to formula. I used Baby’s Only. At the time I was using Baby’s Only, they only had a toddler version. They know have an infant version which is recommended. Infant formulas that are labeled “infant” have strict standards, so make sure you’re picking an infant formula.

Since I am not a nutritionist, I suggest you head to @babyformulaexpert website for how to choose a formula that’s right for you and your baby.

Dr. Young also has an incredible resource page with downloadable PDFs about formula.

How much should my baby be eating per day?

In general, babies of 0-12 months take anywhere from 24-32 ounces of breastmilk or formula per day. When babies are younger, they eat more often and take smaller amounts at each feeding. When babies are older, they go longer between feedings and take larger amounts per feeding.

However, some babies may take less or more than 24-32 ounces. Some examples of babies who may take lower amounts are preemies or babies with severe reflux (you’ll be in touch with your neonatologist, nutritionist and GI doc if so). If your baby is not meeting the minimum, talk to your doctor and have weight checks to make sure baby is gaining appropriately.

Some babies take more than 32 oz, and in most cases this is ok! Finn was a very big eater and would take 36oz per day. Some babies just need more calories than others.

Always been in touch with your provider to make sure baby is gaining appropriately.

European formulas – what’s the hype?

Ok, Dr. Young, you need to do a takeover for me! I am NOT a nutritionist – so again forwarding you to this VERY informative and detailed article on European vs. American formulas.

When do I use a hypoallergenic formula? Does hypoallergenic formula deprive my baby of any nutrients?

Here’s some great info from Dr. Young.

My baby has a dairy allergy, what formula do I use?

If your baby has a true dairy allergy, you should be using a non-dairy formula or a formula specifically made for dairy allergy/intolerance (such as Nutramigen). You should also be in touch with a pediatric allergist and gastrointestinal specialist.

Unfortunately, many babies who have dairy allergy/intolerance also have soy allergy and intolerance.

Here is an article from the Food Allergy Research and Education website about dairy allergies – signs and symptoms and everything you’ll need to know about proper diagnosis and treatment. If your baby has a true allergy, you should see a pediatric allergist and a gastrointestinal specialist.

Take a minute to read my reflux post. I have seen time and time again milk protein intolerance and reflux misdiagnosed and mistaken for overtiredness. Read the testimonials!

Is Nutramigen necessary/worth it? It’s SO EXPENSIVE! How do I know my baby actually needs it?

I have a great post about reflux, it’s misdiagnosis, and formulas that can be helpful for reflux linked here. Your baby may have a true intolerance to dairy and may need Nutramigen, but try to rule these tips out while on Nutramigen to see if you see a change (with the go ahead from your provider!). Then ask your provider about changing formulas for good.

Generic brands – are they the same as name brands?

This is a loaded question! It’s hard to say without looking at ingredients. Again, Dr. Young’s article on generic vs. name brands for the win.

How can I prep formula in bulk in advance?

A FORMULA PITCHER! – This will save you so much time! Watch our reel on how to use it!

Did you know that premixed formula can be stored in the refrigerator for 24 hours? This means you can make 24 hours worth of formula only ONE TIME a day!

Always add water first, then powdered formula. Then refrigerate, pour, warm, and serve.

When do I use a preemie formula?

Only use a preemie (premature) formula if directed to do so by your provider. The ingredients are different and designed for premature babies.

How do I wean breastfeeding and introduce formula?

Click here for my weaning post. We have a step by step e-guide to help you wean to formula.

Organic formulas – what do you recommend?

This is a loaded question! Every baby is so unique. I can only share my experience. If you missed this above:

I used Baby’s Only for Finn. Bobbie was not out yet. I love both now!

Earth’s Best is also readily available at most grocery stores.

Other popular organic brands are Happy Baby and Burt’s Bees – have not personally used either).

When do I know to increase the nipple size on the bottle?

I have a great bottle feeding post that you should check out!

In general, if baby is taking more than 30 minutes to finish a feeding or is “collapsing” the nipples (the nipple is completely flat when you remove it, or baby is unlatching from the bottle and relatching often) it’s time to upsize.

Do I measure the water or powder first and then add water?

Follow the specific instructions on the formula label. In general, you should always add water first, then powder. The total ounces may be more than the water content you added.

Can I use tap water for formula?

Follow the specific instructions on the formula label. In general, sterile, boiled, or nursery water should be used for formula. A great way to save time is to boil water once a day, let cool to lukewarm, add water and formula to a formula pitcher and refrigerate. See formula pitcher how to above. Then pour, warm, and serve as needed.

The guilt associated with formula – how can I overcome it?

Ugh, I know the feeling. Society makes us feel guilty about using/supplementing with formula. We are so hard on ourselves as moms. You are allowed to have those feelings, however what we need to focus on is the TRUTHS!

Our baby is being fed
Formula gives me a mental and physical break that is healthy for me and my baby
Partners/family can be more involved and take more responsibility
I am NOT a failure for using formula because my baby is healthy and being fed
It’s no one’s business if I choose to formula feed, supplement, or breastfeed.

If we focus on these truths, we can create a positive association around formula!

What is the closest formula to breastmilk?

One of my favorite formulas that has a protein ratio closest to breastmilk is Bobbie Formula (use code BUMBLEBABY10 for discount). Read my post on why I love Bobbie Formula!

Formula is a good alternative to breastmilk, especially if baby isn’t getting what they need from the breast.

YOU have to decide what’s important to you in a formula:

Cost
Convenience
Organic
European vs. American
If you are using formula as a supplement or as a main food source
Your baby’s specific needs, such as prematurity, reflux, allergies

For me, convenience was key, so European formulas were out the window. Organic was important to me. I was supplementing minimally, so cost wasn’t as much of a factor. Finn did not have any specific needs in regard to formula.

Since I am not a nutritionist, I suggest you head to @babyformulaexpert website for how to choose a formula that’s right for you and your baby.

How can I supplement with formula?

There are many ways to supplement with formula! Here are some examples:

Breastfeed from the breast and then offer a formula bottle
Feed a bottle with a combination of formula and breastmilk
Feed one bottle of breastmilk and another bottle of formula
Only breastfeed when baby is near and offer only formula when you are away from the baby
Breastfeed every other feeding and offer formula or a combination of formula and breastmilk in a bottle for the other feedings
Replace feedings with formula and store breastmilk that you pumped during this replacement
Combine any amount of formula with any amount of breastmilk in the same bottle

**see formula guidelines for timing of when to use combination bottles

Once my baby eats a bottle, how long is it good for? Can I put it back in the fridge for a later feed? How long is formula good for in room temperature?

Use within 1 hour of touching baby’s lips (you cannot use after 1 hour/you cannot refrigerate after use, it must be discarded). Follow instructions on the back of your can.

Formula is good 4 hours in room temperature untouched.

Can I mix breastmilk and formula? Or do I have to offer one or the other/one after the other?

You can absolutely mix any amount of formula with any amount of breastmilk. See above “How can I supplement with formula” and “formula guidelines” for more information.

Can I continue formula after 12 months – is there any benefit to this?

There is no need to feed formula after 12 months of age unless instructed by your doctor (for example, if you have a preemie). Plus, it’s expensive! The transition to another form of milk (cow, goat, almond, etc.) can happen usually as early as 11.5 months with the OK from your provider. Here is the link from my IGTV on how to transition.

How do I transition from formula/breastmilk to whole milk or other milk?

Download our e-guide here! It’s a step by step guide to help you wean to whole milk/alternative and a sippy cup.

What formulas are good for babies that are prone to constipation?

It is common for formula fed babies to have constipation. If your baby is struggling with true constipation (hard, pebble like stools that are extremely hard/painful to pass), talk to your provider about possibly adding a bottle of water per day (depending on baby’s age) and/or adding a few ounces or prune or pear juice per day to regulate baby and help with the passage of stools. If baby is eating solids, offer pureed prunes and pears to help regulate also.

Palm oil is a common culprit of constipation. Bobbie infant formula contains no palm oil and may benefit your baby’s digestive system.

Just because your baby doesn’t poop every day doesn’t mean that they are constipated. Many babies can go days without pooping and this is still considered normal.

When you make the switch to formula or add in formula, your baby’s stool habits may change. This is common! Be on the lookout for diaper rash (click here for my diaper rash remedy!) and constipation as you are making the transition.

What formulas are good for babies that are prone to reflux?

I have a great post about reflux, it’s misdiagnosis, and formulas that can be helpful for reflux linked here.

The first ingredient I see in formula is sugar. That’s bothersome to me.

DON’T FREAK! All sugar is not created equal, but is an essential ingredient in formula (and breastmilk!) Read more here from Dr. Young.

How will supplementing with formula affect my supply?

This depends on a lot of factors:

If you are supplementing after a feeding
- This will only affect your breastmilk supply if you are cutting feedings short to supplement.
- If you have low supply, this will most likely not affect your supply negatively. Keep offering the breast first and supplement after.
If you are replacing breastfeedings/pumping sessions with formula
- If you are replacing breastfeedings/pumping sessions with formula, your supply will decrease in most cases

If you’re curious on a plan to keep breastfeeding and start supplementing or cutting back on some feeds, book a FaceTime session with me to hash it out. If I think it’s best, I will recommend a breastfeeding consultation.

If you want to wean, check out my weaning highlight on IG.

REMEMBER: BREASTFEEDING DOESN’T HAVE TO BE ALL OR NOTHING!

Do formula fed babies sleep better at night? Should I be supplementing before bed?

THIS IS A MYTH!!! Well, to some extent.

Breastmilk and formula have the same calories per oz (19-20 cal/oz). If your baby is not being fed enough due to low supply or something anatomically related such as a tongue or lip tie, then they WILL sleep better when you supplement (combo, BM or formula) because they will be getting the calories they need. However, formula itself does not make babies sleep deeper or longer.

When’s the best time of day to supplement? How do I prevent waste of formula?

If your baby is consistently finishing bottles, increase by 0.5-1oz for 1-2 days. Keep increasing as baby is finishing. You can ALWAYS add more!

It is normal for babies to take different amounts of formula at different times of the day, especially if your baby is sleeping through the night. If you baby is on solids, you can always add excess formula to purees as long as it is finished within 1 hour of the bottle.

Stages of formula – do they matter?

Again – forwarding you to @babyformulaexpert – Is age specific formula really legit?

Is fed really best?

YES YES YES YES YES. ALWAYS.

I am a FIRM BELIEVER in this. Underfed babies can have lifelong complications such as seizures and brain damage from low blood sugar, brain damage from high bilirubin levels due to malnourishment, stunted physical growth and brain growth due to malnutrition and failure to thrive.

Equally as important is your mental health as a parent.

Mamas who struggle with low supply – IT IS NOT YOUR FAULT. IT IS OK TO SUPPLEMENT/STRICTLY FORMULA FEED.

IF YOU STRUGGLE WITH MENTAL HEALTH AND TAKE MEDICATION, IT IS OK TO STOP BREASTFEEDING OR NEVER BREASTFEED AT ALL.

Formula is NOT a marketing scam. It saves the lives of babies every single year (and parents, too).

Formula is NOT the F word.

Fed and informed is best – and feed in a way that works for your entire family. THAT’S what makes a happy baby and parent.

How do I know if my baby isn’t tolerating a certain formula?

If you are transitioning to formula from breastmilk or are starting to supplement with formula, you may notice that your baby’s bowel habits change. It’s common for formula-fed babies or babies who are being introduced to formula to have a change in bowel habits such as new onset of constipation or diarrhea.

Remember that true constipation is the difficult passage of hard, pebble-like stool. It is also normal to notice a change in the consistency of baby’s poop with formula. Babies who are mostly breastfed will have stool that is yellow to green and seedy, and the contents absorb mostly into the diaper. Formula fed babies tend to have stools that are thicker in consistency (similar to soft serve ice cream) that can range in color from yellow to brown to black. When transitioning, you will see this change over a few days.

When to call your doctor:

If your baby has gone more than 3-4 days without pooping.
If there is a noticeable change in baby’s behavior or baby is inconsolable.
There is blood in your baby’s stool or baby’s stool looks like grape jelly
Your baby has persistent, new onset vomiting.
There is blood or a coffee ground look to your baby’s vomit
Your baby’s stool is white or grey
Your baby’s abdomen is hard and distended
You baby has persistent constipation with a new formula
You have a feeling that something is going on with your baby. ALWAYS trust your gut!

When can I reduce the amount of formula my baby gets per day? When I start solids?

Your baby will naturally reduce the intake of formula as the amount of solids increase, generally around 9-10 months of age. Some babies do not decrease the amount of formula at all when on solids. Don’t limit formula or breastmilk, let baby lead the way as every baby’s needs are different!

What are your thoughts on formulas that contain DHA?

Again, forwarding you to @babyformulaexpert; Specialty Ingredients.

MY FAVORITE FORMULA ESSENTIALS:

I have all of my favorite Formula Essentials listed on my Amazon page.

PackIt cooler bag – you guys know that I LOVE this cooler bag for breastfeeding or formula (or a combo!) mommas! It’s easy to travel with on trips or for everyday use in your diaper bag.

Formula dispenser – great for trips or everyday use too!
Formula mixing pitcher – this is a must for making formula in bulk ahead of time and it saves you so much TIME!
Bottle brush – I like this one because it stands straight up to dry
Puracy Natural Baby Dish Soap – I like this one because there are NO harsh chemicals

Baby Brezza – this is definitely more of a luxury and not an essential….but this splurge item is basically like a cappuccino maker for formula bottles! it mixes the right amount of water and formula within seconds and leaves you with the perfect bottle at the right temp!
Dr. Brown’s Breastmilk and Bottle Warmer – I like this one because it can be used for breastmilk or formula!
- I also like the Baby Brezza bottle warmer too!
- This Formula Ready baby water kettle is also a good option
Large and absorbent burp cloths – I love these Copper Pearl burp cloths because they’re large and absorbent (and come in cute prints like these for a girl or these for a boy)
Drying rack for bottles and parts – this Boon grass drying rack is a favorite at our house (and get this twig accessory because you can hang bottle nipples and pacifiers on it!)
Dishwasher basket – holds bottle nipples and any small parts
Bottle sterilizer and drying machine – works like magic!

Have more questions? Schedule a text or video chat consult with Kate, Lauren or Natalie (NICU RNs) and they can help answer any questions that you have!

BOOK CONSULT NOW

Helpful webinars and e-guides:

Helpful formula posts Instagram Guide
Baby formula expert course – Dr. Bridget Young’s step-by-step method to finding the right baby formula with confidence! Use code BUMBLE for discount
Understanding baby formula webinar – Dr. Bridget young, a formula specialist, explains the differences and components in formula to help you choose the best one for your baby.

Watch our bottle refusal workshop! Watch our recorded workshop, “Bottle Refusal and Tips.” Join Lauren, NICU RN and mother of 2, discuss tips for bottle refusal in infants. She discusses different strategies for avoiding bottle refusal along with tips and tricks for reversing bottle aversions. She also goes over alternative methods for giving breast milk/formula to babies who have ongoing issues with bottle refusal.

WATCH BOTTLE WORKSHOP NOW

Other blog posts you will love:

Remember that fed and informed is best – and to always feed in a way that works for your entire family. THAT’S what makes a happy baby and parent!

*This advice is never meant to replace that of your provider. It’s simply to educate you in order for YOU to make the best decision for your family and baby. Bumblebaby makes a small commission on some of the items listed above

Kate Arquilla

Kate is the mama of 3 kids under five years + uses this and her experience as a NICU nurse to bring parents realistic advice. Kate created a team of four supportive and empowering mothers to help run Bumble Baby! Together we blend our expertise and offer services on topics ranging from infant feeding to maternal mental health. Welcome to our cozy corner of the internet!