If you are parents who are not able to, or choose not to, breastfeed, you will have to depend on commercial baby formulas to meet the needs of your little one. Even if you are breastfeeding it is often convenient to top up with formula from time-to-time.

Your doctor can help you decide on the type of baby formula you could use. If your little one has specific requirements like if he/she is premature or is born with some illness or deficiencies, then your doctor can prescribe a specific product to cover these requirements.

There are so many brands on the market that most parents need to do thorough research before settling on one product. But no matter how thorough your research, it may so happen that your little one is unable to adjust to the product, forcing you to look at alternatives.

Switching baby formula should be done systematically, else your baby may suffer severe stomach upsets.

To begin with, most doctors would prescribe you basic milk-based formula if your baby is normal for age without a proven allergy to cow’s milk.

However, you may need to change or switch the product if your baby is not tolerating this product or a specific brand.

The million dollar question – how do you know that your baby is not tolerating the product?

Well, there are some signs that you need to pick up which if present suggest that your baby is probably not tolerating the product that you are using currently.

These include:

  • Poor weight gain – This is probably the most important sign that the formula you are using is not right for your baby if you are using an adequate amount as prescribed by your doctor. Most babies lose weight in the initial few days due to loss of fluids but regain it within 14 days. Following this, babies gain about 6-7 ounces in a week for about 3 months. After that, babies gain about 4-5 ounces in a week. This is a rough guide. It is always a good idea to track weight and chart it to know if your baby falls above the acceptable percentile for age and health condition.
  • Less diaper output – if your baby is not passing adequate stools in quantity and frequency, you should suspect that the product is probably inadequate for your baby. To recognize this you need to know the diaper output as per age from your doctor. Most babies wet their diapers at least 6-8 times in a day. Also, stools should be passed at least once or twice in a day.
  • Signs in Stool – a consistent abnormal consistency in stool is suggestive of baby formula intolerance. If you find blood in your baby’s stool, that again could be due to intolerance to the baby formula you are using. Food allergy causes inflammation in the intestine and you could find blood in the stool. This allergy could be related to protein in cow milk. Passing multiple loose stools with reduction in urine output suggests food intolerance. Alternatively, severe constipation is also possible due to food intolerance and food allergy. Most babies pass stool at least once a day or may go up to once in two days. If the frequency is below that, it could mean that your baby has intolerance or food allergy. You might also see your baby straining but producing a small quantity of hard stool, another sign of food intolerance.
  • Passing excessive gas – excessive gas is not relieved by basic exercises like bicycling and causes repeated colic and an irritable baby.
  • Refusal to feeds – Now your baby cannot refuse the feed by speaking, but you might find signs of resistance. Your baby may start crying and fussing when you begin the feed. Your baby might be hungry but might refuse to feed on what is provided. These are signs of intolerance that you need to recognize. An inconsolable baby suggests the possibility of an intolerance to feed.
  • Excessive spitting – Spitting is normal for babies. They spit up because their digestive systems are not properly developed. Also, a lot of air is taken in while gulping down milk from the bottle. This air comes out while you burp your baby. But some babies continue to spit up even after adequate burping. Even the amount of spit is important. More than 2 tablespoons of spit up after every feed is a red signal.
  • Vomiting
  • Skin changes – Some babies may show skin changes like eczemas, hives and rashes.
  • Wheezing
  • Anaphylactic shock – this is an emergency condition.

In case your baby shows any of the above signs then please contact your doctor and get your baby evaluated to see if he/she suffers from food intolerance and requires a switch in food formula.

Baby formula powdered milk on silver plate

What are the options in baby formula?

There are an insanely large number of baby formula products that are enough to drive any parent or potential parent insane!

Take the help of your pediatrician to help you with making the choice. Your baby’s doctor’s experience may save you a lot of trouble and experimental trials and errors.
Broadly, there are a few categories of baby formula depending on the basic ingredient in the formula.

It is this basic ingredient which forms the bulk of the product and is largely responsible for providing the major nutrient categories.

Other nutrients, usually minor ones, are added depending on the requirement.

  1. Milk-based baby formula – this is the basic and standard formula where whole cow’s milk is the base ingredient. It contains proteins, casein and whey. Cow’s milk is the natural ingredient that comes close to human milk. However, cow’s milk is designed for the calf and it contains proteins that are much larger than proteins present in human milk. This may cause some difficulty in digestion. Most babies overcome this difficulty and adjust well in a few days. However, some others never settle down due to allergy to the protein components. Some milk-based baby formulas add whey in the milk to emulate human milk.
  2. Soy-based baby formula – Soy is an alternative to cow’s milk, to form the base of the baby formula. It is plant-based, and some conditions warrant that soy be used rather than cow’s milk. Your pediatrician will help you with that. Often, babies who exhibit intolerance to milk-based baby formula find it difficult to tolerate soy-based baby formula too. Babies with dairy intolerance and often intolerant to soy and hence it is not recommended.
  3. Hydrolyzed baby formula – This is an alternative to full or intact milk. Hydrolysis is the process of breaking down complex compounds like proteins and complex carbohydrates into simpler products so that it becomes easier for the baby to digest. The degree of hydrolysis varies from partially to fully to extensively hydrolyzed products. You will need to choose the right product based on the condition of the digestive system of your baby and tolerance levels. Such products are often recommended from the beginning for babies who have a family history of digestive and non-digestive allergies, gastric reflux etc. Extensively hydrolyzed baby formula is the more commonly known ‘hypoallergenic’ form in which all milk proteins are mostly broken down to free amino acids. It may be tolerated by babies who are allergic to the standard milk-based baby formulas. Hence, it is also called ‘predigested’ form.

    How do you switch your baby formula brand?

    The following approach can help you deal with this tricky situation:

    1. Meet your baby’s pediatrician – it is a good idea to make a diary of how many times your baby throws up or passes urine, stool, nature of the stool, take pictures of the stool if possible. Meet your baby’s pediatrician and get your baby evaluated to know how well he or she is growing. At times, you might just be fretting over nothing, and everything might be just fine. It is better to seek professional help before making any decisions regarding changing your baby’s formula. It is important so that you do not misunderstand normal or physiological activities of your baby and unnecessarily switch products disturbing your baby’s digestive system.
    2. Deciding on the basic type of formula for your baby – You need to do this with the help of your pediatrician. Your baby’s doctor will help you understand your baby’s symptoms and signs and whether he or she is really allergic to any particular food component. You need to decide which of the categories of baby formula you want to choose.
    3. Completing the switch – This is the most important step in transitioning your baby from one formula to another formula. The transition should be easier if you are moving from milk-based to a hydrolyzed baby formula. The same cannot be said in the vice versa situation. In the former situation, you need not give any time for switching. You can just change from day 1 and there should not be any problem. In the latter situation however, you need to start by mixing the two formulas in different proportions depending on the tolerance. You may begin with half and half, if well tolerated, you may continue this proportion. However, in case of any symptoms of intolerance, you can use one-thirds of the new formula and two-thirds of the old one until tolerated. Depending on your baby, your pediatrician may also prescribe following the 1:3, 1:1, 3:1 and then finally using only the new formula. Some pediatricians do not advocate mixing in which case you can alternate with the meals and observe. Keep the old formula for the night, but you can introduce the new baby formula during the day to observe how your baby responds. You can increase the proportion of the new formula gradually in a stepwise manner to improve tolerance. Keep a watch for side-effects and symptoms mentioned in the above paragraphs.

      Why and how to switch brands?

      Even though the type of product may be the same, some minor ingredients vary from brand to brand. Several minor nutrients like vitamins and minerals are added to fulfill all the nutritional requirements of the growing infant.

      At times, babies may be allergic to these minor ingredients and some components of preservatives that are added to the baby formula. Here the symptoms of the baby may not be so severe and weight gain may not be an issue. However, you may feel that your baby might be a bit fussy or produce some excess gas with repeated colic attacks.

      Consult with your baby’s pediatrician and consider changing the brand. Here, you may need to read the small print ingredient list carefully to understand which product your baby might be allergic to and how to avoid the unwanted reactions.

      Woman preparing formula milk on a feeding bottle

      You should not fear switching between baby formulas if found necessary. It is better to switch rather than make your baby suffer from digestive issues, allergic conditions, and poor growth and immunity. Importantly, monitor your baby how he or she is tolerating the new feed. You can also understand from how your baby receives the feeds whether he or she is liking it.

      Remember to give your baby 4 to 5 days to tolerate the new formula. Even if you begin a new diet, you do take about a week to settle down, don’t you? Do not be afraid if your baby throws up or has bad stools. As long as the diaper count is fine and your baby is gaining adequate weight, is active and not fussy or irritable all the time, you are doing just fine. It cannot be emphasized enough that you need to make any switches only with the consultation of your baby’s pediatrician.

      Mom bottle feeding her baby
      colored medicine tablets and pills
      Toddler eating cake on a wooden tray
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      Dr Kavita Ramanathan

      Dr Kavita Ramanathan is a practising pathologist with over 12 years of clinical experience. Having completed her MBBS and MD in Pathology from the University of Mumbai, she went on to work for several institutions in India. As a medical writer, she writes to give practical tips to the non-technical audience.

      As a mother to a young girl, motherhood is a topic that is close to her heart. Her own experience in raising her daughter while balancing her residency and medical career has taught her many practical aspects of successful child-rearing. Her knowledge of medicine and skill as a writer appeals to a broad spectrum of parents and mothers.