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Baby formulas

Baby formula buying guide

Last updated: November 2012
Getting started

Getting started

If you don't breast-feed, need to supplement breast-feeding, or decide to wean your baby before age 1, you'll need to give him formula. Usually derived from cow's milk, formula provides a wide range of nutrients but not all the crucial components of breast milk.

A healthy newborn is capable of breast-feeding within the first hour after birth. Experts say breast-feeding is the best thing for your baby and may also reduce the risk of sudden infant death syndrome (SIDS). As an added bonus, breast-feeding also has benefits for mom--and it's much more economical than formula. That said, there are plenty of reasons parents opt for formula, including their work situation.

Until your child is about 6 months old, breast milk or formula will take care of breakfast, lunch, dinner, snacks, and those middle-of-the-night wake-up calls. That's all your baby needs to grow healthy and strong. Then you can begin adding so-called solid food to the mix--continuing to breast-feed and/or supplement it with formula--until your baby's first birthday or so, when cow's milk becomes an option.

Steve Abrams, M.D., a neonatologist at the Baylor College of Medicine and a member of the American Academy of Pediatrics Nutrition Committee, says formula-fed infants, on average, will drink 25 to 30 ounces a day for most of their first year. He notes that in the beginning, infants might take only half an ounce to an ounce per feeding. The amount a baby drinks will usually decrease once he starts eating solid foods.

The best advice is to try breast-feeding if you can. "Unquestionably, breast milk is far superior to any formula designed for babies, and even more critical for the health of the premature baby," says Jane Morton, M.D., F.A.A.P., on the website of the American Academy of Pediatrics (AAP). "The challenge lies in making breast-feeding, or providing a mother's own milk for her baby, a comfortable, enjoyable, and manageable part of the new mother's life."

The AAP and the World Health Organization recommend breast-feeding, and doing it exclusively for the first six months. In cases where breast-feeding isn't working, moms should pump their breast milk and give it to their child in a bottle. The AAP advises that, "Babies should continue to breast-feed for a year and for as long as is mutually desired by the mother and baby." (The World Health Organization and UNICEF recommend that mothers continue to partially breast-feed for up to two years or more.)

Keep in mind that many parents opt for a combination of breast-feeding and formula, adding in bottles once their baby has established a nursing routine.

If you decide to supplement breast-feeding with formula, consult your pediatrician about how best to proceed. So your milk supply won't run out, you'll probably be advised to breast-feed at regular times each day, such as first thing in the morning and again at bedtime.

Benefits of breast-feeding

Nursing is good for babies. Even the infant-formula companies will tell you that, as Similac does on its website: "Breast-feeding is the first and best way you can promote your newborn's health and development."

Breast milk contains a superior mix of carbohydrates, amino acids, fats (including omega-3 fatty acids), hormones, growth factors, antibodies that optimize the development of the immune system, factors that decrease inflammation, components typically known as probiotics and prebiotics, which contribute to a healthy digestive tract, vitamins, minerals, and enzymes that work to give your baby the best possible start. When you're breast-feeding you generally also don't have to worry about sterilizing bottles or measuring and mixing formula.

Commercial formula can simulate but not equal breast milk. Breast-feeding may also reduce the risk of a range of infectious diseases, including bacterial meningitis and diarrhea, as well as respiratory, urinary-tract, and ear infections. Gerber, which makes several types of formula, notes that breast milk is "… your baby's ideal source of nutrition and protection against allergies."

It also might enhance your baby's brainpower and visual acuity. In addition, the AAP has said that babies who are breast-fed rather than formula-fed may have less risk of asthma, diabetes, and certain forms of cancer through adulthood. They're also less likely to be obese as they grow up.

Breast-feeding protects moms, too. It lowers the levels of some cancer-related hormones in the mother's body. At the end of breast-feeding, the body gets rid of any cells in the breast that may have DNA damage, according to the American Institute for Cancer Research. Breast-feeding moms also may be better protected against ovarian cancer and bone-weakening osteoporosis. The World Health Organization says breast-feeding "reduces risks of breast and ovarian cancer later in life, helps women return to their pre-pregnancy weight faster, and lowers rates of obesity."

Financially, breast milk is a bargain. The cost of formula, on the other hand, can add up. In fact, if your baby is consuming only formula, you're likely to shell out more than $1,400 by her first birthday, depending on her nutritional requirements and the type of formula you choose. And a study found that breast-fed infants had fewer hospital admissions.

Why babies don't need water

You may wonder if it's OK to give your baby plain water, or if your baby needs it, especially in the summer. The answer is no. During the first year of a baby's life, you don't need to supplement formula with bottles of water--even on hot days. In fact, giving infants water can be dangerous because they can easily suffer from water intoxication, a condition in which their developing kidneys can't excrete water fast enough. As a result, water builds up in the body and dilutes the electrolyte balance of the blood, which can cause seizures, coma, or even death. Give your baby a little extra breast milk or formula instead of water if you sense that she's thirsty on especially hot days.

Consumer Reports has not Rated infant formulas.

Types

Formula comes in three versions: powder, concentrated liquid, and ready-to-feed liquid. Besides standard formula, which is cow's milk-based, there are special formulas, such as lactose-free and lactose-reduced for babies who have problems digesting lactose, a natural carbohydrate found in milk. Specialized formulas are available as options for babies with an allergy to cow's milk protein.. Protein hydrolysate formula may be prescribed for babies who are allergic to milk or soy. This type of formula can be easier for some babies to digest. Soy formula is an option if you prefer that your baby have a vegetarian diet. (To learn more, see our Features section.)

Increasingly, there are a variety of formulas aimed to reduce spit-up and ease diarrhea, fussiness, gas and colic. You'll also see formula made for pre-term and low-birth-weight babies, older babies, and toddlers. Your pediatrician is the best source of advice on what to feed your baby. But your baby's preferences and nutritional needs will affect the choice, too. If your baby doesn't take to the first formula you pick, it often simply comes down to trial and error. If your baby has any reaction to an infant formula, see your pediatrician. Problems with formula should also be reported to the Food and Drug Administration, which regulates infant formula. (1-800-FDA-1088; www.fda.gov)

While you may have to experiment to find a formula that works well for your child, Steve Abrams, M.D., a neonatologist who sits on the AAP's Nutrition Committee, cautions that parents should be careful about changing formulas frequently. "You should discuss it with the pediatrician instead of picking a formula that you think will solve the problem," he says.

A word about water: If you choose a type of formula that needs to be mixed with water, you might be fine using tap water depending on where you live and your water source. The American Academy of Pediatrics (AAP) recommends that if you use well water or are concerned about the safety of your tap water, you should boil it for about a minute and then let it cool before you add it to the formula. You can also use bottled water, but that will add to your expense. The American Dental Association says it is fine to use tap water with fluoride in it to reconstitute formula, but your pediatrician can give you specific advice about using the tap water in your area. (Using fluoridated water might increase the chance of mild enamel fluorosis, which usually changes the appearance of the enamel but doesn't affect the health of your child's teeth.) If you are concerned about this, you can use a reverse-osmosis filter to remove the fluoride, but these filters are expensive. Keep in mind that some fluoride is necessary to protect teeth. Always use the exact amount of water recommended on the label. The Food and Drug Administration recommends boiling cold tap water for a minute, although the AAP doesn't say that this step is necessary.

Formula doesn't need to be heated for proper nutrition. You can warm up your baby's bottle if you like but never in a microwave since that can cause hot spots to develop in the formula that could burn your baby. It's safer to warm milk by putting the bottle in some warm water. Sprinkle a little formula on the back of your wrist to test the temperature before giving it to your baby. For more on using water and preparing bottles safely, see Formula and breast milk health and safety tips.

Powdered formula


Formula that comes in powdered form is the least costly type you can buy. In our informal survey of stores around the country we found that Enfamil Premium Infant Formula, for example, cost 27 to 35 percent less than Enfamil Premium Ready-to-Feed formula, depending on store type.

The downside is you'll have to carefully measure the water you add to make sure your baby is getting the right concentration of nutrients. According to the FDA, it's best not to prepare several bottles at a time, which means you're in for a lot of mixing.

Gerber Good Start Protect Formula, shown, is an example of a milk-based powder formula for babies up to 12 months. The formula comes in a plastic container with a scoop. You add 1 level scoop of powder for each 2 fluid ounces of water, and mix. It comes in two sizes, 12.4 ounces and 23.2 ounces. We found that a 23.2-ounce container cost about $21 to $25 depending on where you buy it.

Concentrated liquid formula


Concentrated liquid is slightly faster to prepare than powdered formula since you don't have to get the powder to dissolve. You will still have to mix it with water, however, and it is more expensive than powder. Enfamil Premium Concentrated Liquid Formula for Infants, shown here, for example, comes in cans and needs to be mixed with water. Prices vary, but we found packs of 12 cans (13-ounces each) ranging from about $57 to $62. Enfamil says you should clean the can lid, shake it well, open it, and then pour equal parts of formula and water into your baby's bottle. Shake or stir well before feeding.

Liquid formula


This type of formula is extremely convenient since the water is already mixed in. It can also be the most expensive. Similac makes a liquid formula that comes in different sizes. Their Similac AdvanceReady to Feed formula comes in a 2-fluid-ounce bottle that you can attach a nipple to, an 8-fluid-ounce "nipple-ready bottle," and a 32-fluid-ounce bottle. The manufacturer recommends shaking them well before opening. Similac's Ready to Feed 32-ounce containers, shown, cost about $38 for a six-pack.

No matter what type of formula you use (pre-mixed liquid, concentrate, or powder) you'll need to make sure you follow all the directions. For example, Similac warns that once its 32-fluid ounce container is opened it should be stored in the fridge. And most manufacturers say that if your baby doesn't finish a bottle of formula within one hour, you should toss it. During a feeding, your baby's saliva can contaminate the formula in the bottle. Once this occurs, reheating or refrigerating won't kill the bacteria. Also, the company says that if you warm formula but your baby decides not to drink it, you shouldn't refrigerate it and reheat it again later; you should throw it out.

Features


Standard formula is based on cow's milk, but there are several special formulas, including lactose-free and lactose-reduced for babies who have problems digesting lactose, a natural carbohydrate found in milk. Protein-hydrolysate formulas are available for babies with a cow's milk or soy allergy. There are also formulas to reduce spit-up, diarrhea, fussiness, gas, and colic, and for pre-term and low-birth-weight babies. Your pediatrician is the best source of advice on what to feed your baby.

Just because there are many varieties available doesn't mean you should repeatedly switch the formula you give your child. Steve Abrams, M.D., a member of American Academy of Pediatrics Committee on Nutrition, cautions parents: "When babies have feeding problems, spitting up, gas, etc., you have to be careful about frequently changing formulas. You should discuss it with the pediatrician instead of picking a formula you think will solve the problem. We encourage people to talk to their doctor and not just go randomly changing the formula."

In addition to the varieties of formula available, most brands on the market now contain several standard additives.

DHA/ARA

Almost all brands of formula sold in the U.S. are now fortified with DHA (docosahexaenoic acid) and ARA (arachidonic acid), synthesized versions of the essential fatty acids that naturally occur in breast milk. DHA and ARA are added because they are thought to promote healthy eye and brain development. The chemical structures of extracted DHA/ARA aren't the same as DHA/ARA found in breast milk. And even formulas with DHA and ARA aren't a perfect match for breast milk because breast milk contains hundreds of components that can't be replicated. (Learn more about Issues with DHA/ARA.)

Iron

The formula that you buy should be fortified with iron unless your pediatrician says otherwise. Although there are low-iron formulas available, the AAP strongly discourages using them because they can increase the risk of infant iron deficiency.

Organic

There's a growing selection of organic formulas on the market as well as organics offered by larger companies, such as Earth's Best Organic Infant Formula, or Similac, which makes Advance Organic Formula in powder and liquid form.

You will also see store brands, such as Walmart's Parent's Choice Organic Infant Formula. Organic costs more than nonorganic, but there are deals to be had online and by buying store brands. A four-pack of 23.2-ounce Parent's Choice Organic Powder Formula at Walmart costs $61. A pack of 48 2-ounce bottles of Similac Advance Organic Ready to Feed formula costs about $64. A pack of 48 2-ounce Similac Advance Ready to Feed costs about $40.

Probiotic and prebiotic infant formula

Many formulas now come with probiotics, the friendly bacteria that normally reside in the gut, where they help break down food and medicine and keep disease-causing bugs in check. Several studies have suggested that infants on antibiotics or those suffering from diarrhea may get some relief when they're fed infant formula containing probiotics. To produce any benefit, a serving must contain at least 100 million live cultures. Talk with your pediatrician to see if you should try a formula with probiotics. If you supplement breast-feeding with infant formula, a probiotic formula isn't necessary since breast milk is a natural source of probiotics.

You may also see formula with a "prebiotic" added, says Steve Abrams, a member of the AAP nutrition committee and a neonatologist at the Baylor College School of Medicine. Prebiotics stimulate and support the growth of healthy bacteria in the gut. They are naturally found in many foods such as fruit and vegetables.

Shopping tips

Don't stock up before the birth

If you're planning to use formula, ask your pediatrician for a recommendation, but don't buy much of it until after your baby is born. Many companies are generous with free samples, and the hospital may load you up with samples when you go home. If you register at a baby store for gifts or word gets out that you're expecting, you may receive unsolicited samples or money-saving checks in the mail from formula companies right around your due date.

Your baby may prefer one type of formula or be able to tolerate only a particular brand, so be prepared to experiment. No matter what brand you settle on, if your baby shows signs of intolerance, such as gas, a rash, persistent vomiting, bloody stools, diarrhea, or any other unusual symptom, consult your pediatrician. You may need to switch brands or change to a hydrolyzed or soy-based formula, or to a formula specially formulated to combat your baby's condition.

Shop at mass merchandisers

In an informal survey of retailers around the country we found that in general, formula prices were lowest at mass merchandisers. For example, we found the following mean prices per ounce for Enfamil Premium Infant Powder: 84 cents at Costco, $1.04 at Walmart and Babies R Us, and $1.06 at Target. We found the highest prices at drugstores--a mean price per ounce of $1.14 at Walgreens and $1.16 at CVS. Supermarket prices were in-between, with a mean of $1.10.

Generally, milk-based formula tends to cost less than soy-based formula, so don't buy soy or another type of special formula unless your pediatrician recommends it.

Sign up for savings

Many formula companies offer exclusive offers and savings on their websites. At www.gerber.com, for example, you can register to receive special coupons. At www.similac.com, joining a membership program promises to bring you up to $329 in rewards, plus partner offers, infant formula, and coupons. You can also check prices with online retailers such as Amazon and Diapers.com, which sometimes offer free shipping.

Use powder, if possible

Powdered formulas are the least-expensive option. Both the FDA and the USDA report that liquid concentrate formulas, which are more convenient and easier to mix than powder, tend to cost more.

Buy big

Across brands, larger cans of formula, whether in powder or liquid form, cost less per reconstituted ounce than smaller cans. Buy the largest cans you can find.

Consider a store brand

Through our informal survey of stores around the country, we found that Walmart's store brand of powdered formula (Parent's Choice) was a bargain at a mean price of 57 cents per ounce compared with a leading national brand (Similac Advance), which was selling at Walmart for a mean price of $1.05 per ounce.

Are store brands as nutritious as national brands? They have to be. According to the FDA, all formula marketed in the U.S. must meet the same federal nutrient requirements, which are set at levels to fulfill the needs of infants. Although infant-formula manufacturers may have their own proprietary formulations, brand-name and store-brand formula must contain at least the minimum levels of all nutrients specified in FDA regulations, without exceeding maximum levels, where those are specified.

Check the "use by" date

When buying formula, look for the "use by" date on the label or lid, which is required by the FDA. Until that date, you can be sure the formula will contain no less than the amount of each nutrient declared on the product label, and will be of acceptable quality.

Be brand loyal

Although major brands of formula are roughly equal, it's generally recommended that you stick with the brand your baby gets used to. But it's fine to use liquid and powder within the same brand.

Cash in with coupons during sales

Before making a trip to the store for infant formula, scout for savings by previewing weekly store ads online, if possible. Then capitalize on sales by bringing any manufacturer's coupons you've been stockpiling and load up on the largest cans you can find. Be sure to check those "use by dates" though--you don't want to buy more formula than you can use before it expires.

BPA in infant formula

Powdered formula is usually not only cheaper than liquid formula, it might be safer, too, because powdered formula tends to be much lower in bisphenol A (BPA), a chemical that has been used in the protective lining in metal-based food cans, including infant formula.

Studies have linked BPA to breast and prostate cancer, reproductive abnormalities, and--for infants exposed in the womb--problems later on, including attention deficit hyperactivity disorder, obesity, and diabetes. A recent study found that people in the U.S. have about double the amount of BPA in their bodies compared with Canadians.

As Consumer Reports tests have found, BPA has been found at varying levels in many canned food products, such as soups, vegetables, and beans, as well as some infant formula.

"Liquid formula contains high enough levels of BPA to cause harm," says Frederick vom Saal, Ph.D., a leading BPA researcher and professor of biology at the University of Missouri-Columbia.

Some manufacturers have tried to address concerns over BPA. For example, Abbott, the company that makes Similac, announced in 2011 that all Similac-brand formulas were "BPA free," adding that this means "no BPA is used in the manufacturing process for the packaging." If you are concerned about BPA, check with the manufacturer of your child's formula to see if it has addressed the issue.

It's important to keep in mind however, that when we tested powdered infant formula and so-called BPA-free baby bottles, we still found trace levels of it, suggesting that given its widespread use in so many other materials, it may not be possible to get to a point of having a product, or packaged infant formula, that is 100 percent free of BPA.

A lack of regulation?

Vom Saal says another problem is that there can be variability in the levels of BPA from batch to batch of the same type of formula.

Another issue: "There is no U.S. regulation about having to report levels of BPA or even what products contain BPA," vom Saal said, adding that the process he used to test for BPA during his 2009 research was far more sensitive than what the industry uses when it tests. Still, while vom Saal said he found BPA in powdered formula containers as well as liquid formula containers, levels in the containers from powdered were much lower. A limited test by Consumer Reports of formula itself (not the containers) also found more BPA in liquid formula than in powdered formula.

BPA is also found in some plastic sippy cups and some baby bottles, although many are now specifically labeled BPA-free, and many states have enacted bans on BPA in children's cups and bottles.

Consumers Union has repeatedly called on the FDA to ban BPA in children's products and food and beverage containers. While the agency announced in January 2010 that it thought there was cause for concern about BPA's potential effect on children and said it supports efforts to produce BPA-free baby bottles and find alternatives to BPA for can linings, it fell short of calling for a ban of the chemical in food contact substances.

Issues with DHA and ARA

As noted in Features, almost all brands of formula sold in the U.S. are now fortified with DHA (docosahexaenoic acid) and ARA (arachidonic acid), synthesized versions of the essential fatty acids that naturally occur in breast milk. DHA and ARA are added because they are thought to promote healthy eye and brain development, though the chemical structures of extracted DHA/ARA aren't the same as DHA/ARA found in breast milk (and even formulas with DHA and ARA aren't a perfect match for breast milk because breast milk contains hundreds of components that can't be replicated).

Although the Food and Drug Administration allows the addition of these DHA and ARA oils to infant formulas, the scientific evidence to support their use is mixed. Some studies in infants suggest that including these fatty acids may have positive effects on visual function and neural development for formula-fed babies. Other studies question whether any long-term beneficial effects exist. "Researchers who conducted a 2008 meta-analysis found no evidence that these additives are beneficial," says Charlotte Vallaeys, director of farm and food policy at the Cornucopia Institute, a Wisconsin-based nonprofit.

Cassie France-Kelly, a spokeswoman for the Martek Biosciences Corporation, which makes most of the DHA/ARA used in infant formula, challenges that. She says, "If it [DHA/ARA] is in breast milk it should be in formula…The WHO [World Health Organization] found convincing evidence that it should be in formula."

Controversy over DHA/ARA

In addition to the inconclusiveness about the benefits of added DHA and ARA, there's controversy about the manufacturing of these fats being compatible with the production of organic infant formula.

All DHA/ARA-fortified formulas sold in the U.S. are made with oils extracted from micro algae and soil fungus respectively. The DHA/ARA manufactured by Martek uses scientific procedures that are Generally Recognized as Safe (GRAS) by the FDA for infants (birth to 1 year) and children 1 to 12 years old.

The Cornucopia Institute petitioned the Department of Agriculture, (which administers the organics food program, to have the oils removed from organic infant formula. (In the European Union the additives are prohibited in organic formula, and claims that they improve cognitive and visual development are prohibited on labels on conventional formula.)

Vallaeys says the processing of manufactured DHA and ARA uses hexane, a synthetic material that is not approved for use in organic production. Hexane is a petroleum-refining byproduct that is a neurotoxin when inhaled, a concern primarily for workers who make DHA/ARA. Martek says that no hexane residue has been found in its formula. Vallaeys says she knows of no independent studies or testing that have been done on hexane residues in any formula that is fortified with DHA. "The whole point of the organic label is that mothers can have that extra level of assurance… The label is supposed to mean it was produced in a way without toxins and unapproved (synthetic) materials." The USDA National Organics Standards Board, which met in late 2011 to review the issue, announced that DHA/ARA extracted with hexane would no longer be allowed into organic infant formula.

Martek and formula manufacturers say that hexane used in making the additives evaporates in the process and has been safely and effectively used in food manufacturing for years, including some cooking oils.

Other DHA/ARA complaints

The controversy extends to whether DHA or ARA might also lead to adverse reactions. Martek (which was bought by another company, DSM Nutritional Products) says it has not seen a statistical difference in people reporting problems with infant formula since it began adding DHA/ARA to infant formula in 2002, according to Cassie France-Kelly, a company spokeswoman. "Regulatory agencies worldwide, including the FDA, have extensively reviewed on numerous occasions the safety of Martek's DHA oils, and have agreed with the conclusion that these ingredients are safe," Kelly says.

Yet the Cornucopia Institute says hundreds of reports were submitted to the FDA by health-care providers and parents of infants who became sick from formula with DHA and ARA. Reported issues have included spitting up, gas, fussiness, constipation, vomiting, and diarrhea after repeated use.

Siobhan DeLancey, a spokesperson for the FDA, says that just because people report a problem doesn't mean it was ever conclusively linked to their infant formula. "Additionally, it's impossible to compare on a wholesale basis how many complaints of any kind are associated with DHA/ARA-free formulas versus those associated with DHA/ARA-added formulas." In a letter responding to Cornucopia in 2011, the FDA disputed that there was any clear link to gastrointestinal "adverse effects" in infants and the DHA/ARA additives.

If you think your baby has suffered a harmful effect from an infant formula, you can report it to the FDA by contacting the agency at https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm. Your pediatrician can also do it for you via the FDA's MedWatch hotline, at 800-332-1088 or online at www.fda.gov/medwatch/report/hcp.htm. The MedWatch progam allows health-care providers to report problems possibly caused by FDA-regulated products such as infant formula.

In any event, it's tough to find any infant formula without added DHA/ARA, even if you wanted to. Baby's Only is the only brand we could find available without added DHA and ARA. It makes a Toddler Formula. (The company's philosophy is that breast milk is best for the early months.) Karla Highman, the company's marketing director, says parents should talk with their pediatrician about using the formula for an infant, since "it meets the nutrition requirements according to the FDA's Infant Formula Act."

For parents who want to make sure their formula-fed babies get DHA, Highman says the company makes a DHA supplement that can be added to its formula. According to Baby's Only, their DHA and ARA are made with "organic high oleic sunflower and/or organic high oleic safflower oil, organic soybean oil, organic coconut oil and egg lecithin." The company also recently released Baby's Only Organic Dairy Formula with DHA and ARA. (It is already added.)

Some parents may be concerned about using Baby's Only DHA/ARA because it is made with eggs, which some children are allergic to. Baby's Only says this is not a problem since they use egg lecithin, which was found to be allergen-free in laboratory tests.

Formula and breast milk health and safety tips

Safe preperation

Before feeding your baby formula or breast milk, you should wash your hands with soap and water just as you would before handling any food. Follow label directions exactly and instruct caregivers to do the same. The Food and Drug Administration says to boil cold tap water for a minute before mixing with formula, but whether boiling is necessary is controversial, and the AAP doesn't say it is a necessity. Your best bet is to follow the formula manufacturer's instructions exactly, and talk with your pediatrician about which type of water to use.

Whatever you decide, you should never try to stretch formula with extra water. Improperly diluted formula can lead to malnutrition and possibly water intoxication, which can be life-threatening. On the other hand, too little water puts an excessive burden on an infant's kidneys and digestive system, and may lead to dehydration.

Mix as you go

If you're using powdered formula, generally use refrigerated bottles within 24 hours of preparation. For liquid concentrates and ready-to-feed products, use within 48 hours of preparation, but check manufacturer's storage instructions. If you use different brands of powdered formula, don't mix up the scoopers; they might hold different amounts.

Don't heat breast milk or formula in a microwave oven, which can create dangerous hot spots. Instead, warm a bottle in a pot of water at body temperature. Shake the bottle before serving to even out the temperature, and test the formula or breast milk on the back of your hand. If it's lukewarm, which is as hot as it should get, it's ready for your baby, although your baby may be fine with cold breast milk or formula, too.

Keep bottles clean

The AAP stresses that all bottles, nipples, and other utensils you use to prepare formula--or to feed your baby--should be clean. If the water in your home is chlorinated, you can simply use your dishwasher or wash the utensils in hot tap water with dishwashing detergent and then rinse them in hot tap water. If you have nonchlorinated water, the AAP recommends placing the utensils in boiling water for 5 to 10 minutes.

Safe storage

Don't leave breast milk or formula out for more than two hours. And never put an unfinished bottle of breast milk or formula in the refrigerator for another time. To protect your baby from potentially harmful bacteria, toss it and start fresh.

To make sure the formula and breast milk you feed your baby are safe, follow these tips from the Food and Drug Administration for storing them in the refrigerator and freezer.

Expressed breast milk can be stored in the refrigerator for 24 hours, kept in the freezer for up to six months (label it with the date you put it in the freezer).

Formula can be stored in the refrigerator for up to two days in individual baby bottles. Freezer storage is not recommended. When using baby formula, observe "use by" dates printed on the container or lid.

Protecting your baby's teeth

Sucrose (table sugar), a sweetener in Similac Organic as well as lactose-free infant formula, can harm a baby's tooth enamel faster than any other sugar. (Lactose is the most common sweetener in infant formula. It's also the sweetener naturally found in breast milk.) "Sucrose acts on bacteria in the mouth to produce acid and form plaque," says Janice K. Pliszczak, D.D.S., M.S., a spokeswoman for the Academy of General Dentistry.

To protect your baby's teeth and still give him a sucrose-sweetened formula, wipe off his teeth with a washcloth or gauze pad after every formula feeding so that a layer of sucrose never has the chance to form. Pliszczak says you can also use a soft baby toothbrush or a "finger toothbrush" for babies that you slip on one finger to gently wipe her teeth. You shouldn't use toothpaste with fluoride for infants under 2 years of age. There are special "baby" toothpastes that don't contain fluoride. Pliszczak says even infants with no teeth should have their gums cleaned.

Also, never put your baby to bed with a bottle of milk, breast milk, formula, or juice, or give her water sweetened with table sugar, all of which can lead to tooth decay.

Research suggests that mixing liquid concentrate or powdered baby formula with fluoridated water might affect a child's baby and permanent teeth as they develop below the gums. The condition, "enamel fluorosis," usually causes faint white lines or spots, although pitting or staining may also occur.

The American Dental Association offers this advice to decrease the chance of fluorosis: If liquid concentrate or powdered infant formula is your baby's primary feeding source, mix it with water that is fluoride-free or contains low concentrations of fluoride. But fluorosis doesn't affect your child's health or teeth. Look for water labeled purified, demineralized, deionized, or distilled, or water filtered by reverse osmosis, usually available in grocery stores for less than $1 a gallon. Your pediatrician may want you to use sterilized water. But sterilization won't remove fluoride. Occasionally using fluoridated water shouldn't have an effect.

You can check the fluoride level in your own tap water with your local water utility. Or go to "My Water's Fluoride" at http://apps.nccd.cdc.gov/MWF/Index.asp.

   

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