Baby Formula: Which Type Does Your Baby Really Need?

Maybe you chose the bottle on purpose. Maybe breastfeeding didn’t work out, wasn’t enough, or wasn’t possible for health reasons. Maybe you’re breastfeeding and supplementing. Every one of those paths is okay—and deserves good information, not commentary from the sidelines.

Yes, breast milk is a baby’s natural food, and no powder can fully copy it. But this is also true: with an infant formula made to legal standards, your baby can be well fed and grow well. Closeness happens in your arms, in your eye contact, in your voice—through every bottle. And in the EU, the “Important Notice” about breastfeeding on every package of infant formula is a legal requirement, not a judgment of you.

If you breastfeed and supplement, a good rule of thumb is: breast first, bottle second. If you want to keep breastfeeding as an option, it helps to know this in advance: every bottle that replaces a breastfeed can reduce milk production. If you’re replacing breastfeeds, it’s best to do it gradually. That gives your body time to adjust and makes painfully full breasts less likely. Going back to more breastfeeding later isn’t always easy, but it’s often worth a try: lots of skin-to-skin contact, frequent latching, and regular pumping can help. If you’d like support, you can get it from a lactation consultant (your health plan may cover it) or La Leche League.

In the US, the FDA regulates infant formula and sets its nutrient requirements. In the EU, a regulation that has applied since February 2020 (and since February 2021 for formulas made with hydrolyzed protein) sets out exactly how much protein, fat, carbohydrates, vitamins, and minerals must be included at a minimum and may be included at a maximum. That helps when you’re shopping:

• The same basics: Every infant formula has a legally defined nutrient composition, regardless of brand or price. The expensive package is not the better one.

• DHA: In the EU, the omega-3 fatty acid DHA has to be included in every infant and follow-on formula. In the US, it’s optional, but many formulas have DHA added. Either way, “with DHA” isn’t anything special.

• Strict limits (EU): In the EU, residues of pesticides are limited to no more than 0.01 mg per kilogram and active substance. Some substances are completely banned from use in growing ingredients—both in organic and conventional formula.

• No health claims (EU): In the EU, nutrition and health claims are prohibited on infant formula, as are words like “humanized” or “adapted.” Rules differ by country.

• Clear labeling: In the EU, “infant formula” is for use from birth, and “follow-on formula” (stage 2 and 3) is only for babies over 6 months. In the US, you’ll mostly see infant formula for the first year and toddler drinks after that.

In the EU, advertising is restricted, too: discounts and free samples for parents are not allowed for infant formula, so most ads there are for stage 2, stage 3, or toddler milk. Rules differ by country.

And the extras? Added probiotic bacteria or fibers such as GOS and FOS have no reliably proven benefit for healthy babies. The “HMOs” in some formulas are individual, manufactured sugar building blocks; breast milk contains more than 100 different ones. A pediatric nutrition committee sees no safety risk, but also no proven benefit, and considers marketing with the term unacceptable. In short: the extras don’t harm, but you don’t need to pay for them.

If you remember just one thing from this article, let it be this: for a healthy baby, a standard infant formula is enough. From the first bottle to the day your child drinks milk from a cup, no other type is necessary.

In Germany, the simplest infant formula is labeled “Pre.” Its protein content is adjusted to match breast milk, and lactose is its only carbohydrate, just like in breast milk. Because it contains no starch, it stays thin. You feed it responsively: when your baby shows hunger cues, at a calm pace, until they show they’re full. Not every cry means hunger.

When solids start (in Germany, sometime between the beginning of month 5 and the beginning of month 7), you simply keep using the same infant formula. There’s no need to switch to follow-on formula. German guidance and the UK health service agree on that point.

Infant formula comes as powder and as ready-to-feed formula in bottles. Both must meet the same rules. Liquid formula is packed sterile and is handy when you’re out, but it costs more, and once opened it has to be used more quickly. The time limit is on the package.

In Germany, “1” formula is also an infant formula, suitable from birth to the end of the first year. In addition to lactose, it may contain other carbohydrates, usually a little starch. That makes it a bit thicker and it’s marketed as more filling.

Do you need that? Usually not. If your baby drinks a standard formula well, is growing, and seems content, there’s no reason to switch. There’s no evidence that babies become calmer or sleep longer at night with a more filling formula. But if you use a starch-added formula, you’re not doing anything wrong: it can also be fed on demand.

Because a starch-added formula is a little thicker, a medium-flow nipple often works better. If the hole is too small, your baby has to work very hard and may end up drinking too little. If it’s too large, the milk flows too fast, making choking or spit-up more likely.

The numbers on the packages sound like a staircase you’re supposed to climb step by step. They’re not. In Germany and the EU, follow-on formula, usually labeled “2” or “3,” is its own category: for babies over 6 months and only as part of a mixed diet with solids. Before that, it doesn’t belong in the bottle. In the US, you’ll mostly see infant formula for the first year and toddler drinks after that.

It’s similar to infant formula, but contains more iron. That still doesn’t make a switch necessary: the rising iron need in the second half of the first year is mainly covered by iron-rich solids, such as the classic first puree in Germany, made with vegetables, potatoes, and meat. German guidance is clear: switching is possible, but not necessary. If you do switch after solids begin, read carefully when buying more: 1 and 2 from the same product line often look almost identical.

After the first birthday, you’ll see “toddler formula,” “toddler milk,” or “growing-up milk.” The European Food Safety Authority sees no special role for these products in meeting toddlers’ nutritional needs, and in the US, the AAP and CDC also consider toddler formula unnecessary. Toward the end of the first year, your child can drink regular pasteurized or UHT cow’s milk, ideally from a cup with meals.

In Europe, this formula is labeled HA, which used to stand for “hypoallergenic”; in the US, it’s called partially hydrolyzed formula. In these formulas, the cow’s milk protein is partially broken down. The idea was that smaller protein fragments would irritate the immune system less and protect babies from families with allergies. For a long time, HA formula was therefore recommended for non-breastfed babies at increased allergy risk.

That recommendation doesn’t apply in the US. The AAP’s position is that hydrolyzed formula does not reliably prevent allergies, even for babies at higher allergy risk who are not breastfed or not fully breastfed. So there is no infant formula that pediatricians recommend specifically to prevent allergies.

What does that mean for you?

• Your baby has an increased allergy risk if at least one parent or a sibling has asthma, hay fever, eczema, or a food allergy. That does not mean your baby will have an allergy too.

• You can choose freely: Even if allergies run in the family, current guidance says you can use any infant formula—standard, starch-added, or partially hydrolyzed. Because the market can change, it’s worth asking at your baby’s next checkup whether a formula with confirmed benefit has become available.

• Partially hydrolyzed formula doesn’t harm: It is safe and meets the same requirements as any other infant formula. It does taste more bitter and cost more. There’s no evidence that it’s easier to digest.

• It’s not an allergy treatment: If your baby has a doctor-confirmed cow’s milk protein allergy, partially hydrolyzed formula is not suitable. In that case, your baby needs a therapeutic special formula, which we’ll cover in the next section.

What experts recommend for allergy prevention is fairly simple: a smoke-free home, not getting a new cat if allergies run in the family, and vaccinations according to routine immunization recommendations. Alongside that, offer a varied solid-food diet without deliberately avoiding possible allergens such as egg, milk, or wheat. Always give egg well cooked, for example hard-boiled or baked into food, never raw or soft-cooked. Goat’s milk, sheep’s milk, mare’s milk, and plant drinks do not protect against allergies.

Specialized formulas are often “exempt infant formulas” in the US and “foods for special medical purposes” in the EU. They should be used only on medical recommendation and with medical follow-up. That’s because spit-up, gas, or lots of crying is often nothing serious—but sometimes it points to an intolerance, a metabolic disorder, or reflux disease that needs targeted treatment. So the first stop is the pediatrician’s office, and only then the formula aisle.

• AR formula (anti-reflux): It’s thickened so the milk stays in the stomach better. But spitting up is very common in babies and usually harmless: if your baby seems content and is gaining weight well, they usually do not need different formula. Thickened formula may be considered if a doctor diagnoses reflux disease that needs treatment. If so, prepare it exactly as directed on the package, since instructions sometimes differ.

• Lactose-free or low-lactose formula: A true intolerance to milk sugar is rare in babies, and gas alone is not a reason to switch. In the EU, if a formula says “lactose-free” and is not soy-based, it must also say that it is not suitable for the rare metabolic disorder galactosemia.

• Soy-based formula: Its protein comes from soy, so it is lactose-free. Because it contains high levels of plant hormones (phytoestrogens), it should only be used for a good reason and after speaking with your pediatrician, for example in galactosemia or if your family is vegan. It is not suitable for allergy prevention. If your baby has a cow’s milk protein allergy, it is not the first choice and, if used at all, is only considered from about 6 months onward.

• Therapeutic special formula for cow’s milk protein allergy: If the allergy has been medically confirmed, there are formulas made with extensively hydrolyzed protein or based on amino acids that your pediatrician can recommend or prescribe. Partially hydrolyzed formula and goat’s milk formula are not alternatives here, and lactose-free formula made from cow’s milk still contains cow’s milk protein. Be careful with formulas marketed for diarrhea: they usually contain regular cow’s milk protein. The allergy is usually diagnosed through a medically supervised elimination trial with the special formula and a doctor-planned reintroduction afterward; a blood test alone does not prove it.

• Formulas for gas, colic, or constipation: There is no convincing evidence for the promised effect. Ask your pediatrician before trying one.

• Formula for preterm babies: For babies born too early or at very low birth weight, the care team decides feeding individually.

Online, you’ll find recipes for “natural” baby milk, and in the dairy case you’ll see goat’s milk and oat drinks that sound healthier than formula powder. But there are real risks here.

• Plain cow’s, goat’s, sheep’s, or mare’s milk: No animal milk has the same composition as breast milk. Cow’s milk contains about three times as much protein as breast milk and more than three times as many minerals. The kidneys have to excrete that excess, which means more water is lost, and during fever or diarrhea dangerous dehydration can result. At the same time, important nutrients may be too low—for example, cow’s milk does not provide enough iron.

• Goat’s milk-based infant formula is different: it is approved in the EU and must meet the same requirements as formula made from cow’s milk. It does not prevent allergies, and it is unsuitable for cow’s milk protein allergy because the proteins are very similar.

• Oat, almond, soy, rice, or other plant drinks: In the first year, they do not replace either breast milk or infant formula. They do not provide enough protein, vitamins, or minerals, and can lead to deficiencies and delayed growth. In the EU, organic drinks may not be fortified with vitamins. Rice drinks may also contain comparatively high levels of arsenic; the British health service advises against giving rice drinks as a milk substitute to children under 5 years old.

• Homemade infant formula: Professional societies clearly advise against it. Even a recipe once developed for this purpose does not meet all of a baby’s needs. Depending on the mix, vital nutrients such as vitamins may be missing, or there may be too much protein and energy. There is also a hygiene risk that makes stomach and intestinal infections more likely.

• Raw milk and other unpasteurized milk: They can contain dangerous germs such as EHEC, Salmonella, or Campylobacter and are off-limits for babies and toddlers, including in porridge.

If money is tight, the cheapest infant formula at the supermarket meets the same requirements as the most expensive one at the pharmacy. Mixing your own is a false economy. And never dilute formula by using less powder or more water: milk that is too thin can cause a dangerous sodium deficiency in babies, including seizures. If you can’t afford infant formula, talk to your pediatrician’s office, or call 211 to find local help.

In front of the shelf, it helps to go through these questions in order:

1. 1

   Is there a medical reason for a specific formula? For example, a confirmed cow’s milk protein allergy, reflux disease, a metabolic disorder, or prematurity. Then use the formula your doctor recommends or prescribes, and don’t switch without checking first.

2. 2

   Do allergies run in the family? Then ask at your next pediatric visit whether there is now an infant formula with a confirmed allergy-preventive effect. Based on current knowledge: no. So you can choose freely.

3. 3

   For everyone else: Choose a standard infant formula. It works from birth to the end of the first year. If you prefer one with added starch, that’s okay too.

4. 4

   Powder or liquid, organic or conventional, supermarket or pharmacy? That depends on your daily life, your values, and your budget. Nutrients and legal limits are set by law.

And then: stick with it. If your baby drinks well, has wet diapers, and is thriving, there’s no reason to keep switching brands. Frequent changes also make it harder to tell what’s causing a change.

Whether a formula “works” shows over days, not from a single feeding. These signs are reassuring:

• Wet diapers: From about day 5, at least 6 heavy, wet diapers in 24 hours. Later there are usually a bit fewer, but they’re fuller—typically 4–6 a day from 3 to 12 months. Pale urine is a good sign.

• Stool: In formula-fed babies, it is usually firmer than in breastfed babies—about like peanut butter—and yellowish to brown. Green is normal too. In the first weeks it often comes 1–4 times a day, later usually 1–2 times a day, sometimes only every other day.

• Spit-up: A sip or two of milk, up to about 1 tablespoon, coming back up with a burp or after a feeding is common and usually harmless as long as your baby seems content and is gaining weight. Projectile vomiting is different: forceful vomiting in an arc, often after several feedings in a row, usually in the first 2 months of life (for example with pyloric stenosis). Have that checked by a doctor the same day.

• Mood: A baby who relaxes after feeding, is alert and curious in between, and grows over the weeks is getting what they need. Some weight loss after birth is normal, and birth weight is usually regained by about days 10–14. After that, what matters is the pattern on your baby’s growth chart at the pediatrician’s office, not a single measurement. At your baby’s checkups, they’ll be examined thoroughly, and you’ll be asked specifically about feeding and digestion.

Pay closer attention if your baby has hard, pellet-like stool, a rash or hives after feeding, mucus or blood in the stool, ongoing vomiting, or isn’t gaining weight. Allergic reactions often show up within minutes to 2 hours, but with cow’s milk protein allergy sometimes not until up to 3 days later. Don’t switch formulas on your own then—have your baby checked instead. And one easy-to-fix cause of hard stool? Too much powder in the bottle.

It can help to keep track for a few days of what your baby drank and what the diapers looked like. In Moonsleep, you can log every bottle with amount and feeding type (Formula, Breast milk, or Other), record diapers as wet or with stool, and add a note if needed, such as “new container.” If more than one person feeds your baby, everyone sees the same overview. That means answers instead of guesses at your next appointment.

Powder formula is not sterile. In rare cases it can contain germs such as Cronobacter or Salmonella, which do not multiply in dry powder but can grow quickly in mixed, lukewarm milk. These infections are very rare, but in the first 2 months of life they can be severe. If the bottle is made fresh and fed right away, the risk for healthy, full-term babies is extremely low. Here’s how to do it:

1. 1

   Wash your hands thoroughly with soap under warm running water. Don’t prepare raw foods on the same work surface at the same time.

2. 2

   Prepare the water: Use fresh water from the cold tap. Let it run first until it feels noticeably cool. In the first months of life, it’s best to boil it first, as German food safety authorities recommend.

3. 3

   Let it cool: Mix the bottle lukewarm. German public health guidance gives 86–104 °F (30–40 °C) so no one gets scalded; German food safety authorities consider about 68–122 °F (20–50 °C) sufficient for healthy, full-term babies. Follow the instructions on your package.

4. 4

   Measure exactly: First put the stated amount of water into the clean bottle, then add the powder. Loosely fill the scoop that comes with the formula and level it with the back of a clean knife—don’t pack it down and don’t heap it. Use only the scoop from that exact package, because scoop sizes differ.

5. 5

   Close and shake until the powder has dissolved completely.

6. 6

   Check the temperature: Put a few drops on the inside of your wrist. It should feel no more than lukewarm—never hot. If the milk is too warm, cool the closed bottle under running cold water as quickly as possible and for no longer than about 15 minutes. Don’t test the nipple with your own mouth, because cavity-causing bacteria can pass from your mouth to your baby.

7. 7

   Feed promptly, discard leftovers: Use the bottle within 2 hours of preparation. Anything left after the feeding should be thrown away, not saved or reheated.

8. 8

   Store powder properly: Keep the package tightly closed, dry, and protected from heat. Don’t leave the scoop sitting in the powder; store it separately and clean.

What water is suitable? In places with safe drinking water, tap water is generally fine. It is not suitable if it comes through lead pipes, from the hot-water tap or a boiler, from household filters, from an untested private well, or from areas with elevated uranium levels. In that case, use still water labeled “suitable for preparing infant formula.”

And why not use 158 °F (70 °C)? The World Health Organization and, for example, the UK health service recommend mixing powder with water at at least 158 °F (70 °C). German food safety authorities see this differently for healthy, full-term babies at home. In a small bottle, the water cools so quickly that germs are not reliably killed anyway. At the same time, the risk of scalding and nutrient losses goes up. What matters most is making feeds fresh, using them promptly, and throwing away leftovers. For preterm babies, babies under 5.5 lb (2,500 g) birth weight, and babies with weakened immune systems, the doctor decides individually—sometimes using sterile ready-to-feed formula.

For nighttime and when you’re out, German food safety authorities recommend portioning the powder into clean, dry bottles and keeping boiled water in a clean, closed thermos. Mix only right before feeding, after checking the water temperature. By contrast, making bottles in advance and storing them—whether in the fridge or kept warm—is not recommended at home: storage is considered the most critical point for hygiene.

Rinse the bottle and nipple right after every feeding so nothing dries on. Then wash with hot water, dish soap, and a bottle brush, rinse well, and let air-dry—for example on a clean dish towel. The dishwasher is fine too.

Whether you should also boil them is assessed differently. Some German public health guidance sees no extra benefit at home for bottles and silicone nipples. German food safety authorities, on the other hand, recommend especially in the first months additionally boiling bottles, nipples, and scoops for at least 2 minutes in boiling water or using a baby-bottle sterilizer. If you want to play it extra safe, boil them in the first months. Rubber latex nipples are more porous than silicone and should be boiled from time to time anyway or replaced more often.

And which bottle is best? There’s no evidence that a particular type of bottle or nipple is superior. Simple bottles that are easy to clean are usually the most practical choice.

The feeding chart on the package is only a rough guide. Healthy babies can adjust how much they drink to what they need, within limits—whether at the bottle or the breast, if we let them. That’s what on-demand feeding, or responsive feeding, is about:

• Notice early hunger cues: Your baby gets restless, makes rooting movements with the head, opens the mouth, sticks out the tongue, or puts fingers in the mouth. Crying is a late hunger cue; feeding often goes less smoothly then because your baby first has to calm down.

• Invite, don’t push: Gently touch the nipple to your baby’s lips. If your baby takes it into the mouth on their own, you’re ready to start.

• Semi-upright and close: Hold your baby semi-upright and slightly reclined in your arms, with eye contact—sometimes in your right arm, sometimes in your left. A baby bouncer or car seat is not ideal for feeding.

• Keep the bottle fairly level: Tilt it only enough to keep the nipple just filled with milk. That way your baby swallows less air and the milk doesn’t flow too fast.

• Allow pauses: If your baby lets go of the nipple, turns the head away, or stops sucking, they need a break or are full. Time for a burp—after that, you can offer the bottle once more.

• They don’t have to finish it: The bottle does not have to be empty, and your baby shouldn’t be encouraged to empty it. Full babies visibly relax, let go of the nipple, and some fall asleep.

Why this matters: babies can be overfed by bottle too, and overly rapid weight gain in infancy is linked to a higher risk of later overweight. If you pay attention to your baby’s cues, their natural sense of hunger and fullness stays intact.

Two things still apply: in the first weeks, until your baby has regained birth weight, they should not go longer than about 4 hours without a feeding at night either—you may need to wake them gently. And if your baby is hungrier on some days, simply make a little more formula in the correct mixing ratio. More powder per amount of water is not the answer; it strains fluid balance and the kidneys.

One more thing about closeness: babies feel more secure when the bottle is mainly given by a small number of familiar people. Even so, feeding can be a team effort. Talk with everyone who helps about what matters to you during feeds, so your baby is fed in a similar way by your partner, a grandparent, or a babysitter.

As a rough daily amount up to about 6 months, around 150 ml per kilogram of body weight (about 2.3 fl oz per pound) is used; for an 11 lb (5 kg) baby, that’s about 25 fl oz (750 ml). Babies generally don’t drink much more than just under 34 fl oz (1 liter) a day; if yours regularly drinks more, talk to your pediatrician. In the first days of life, the amounts are much smaller and increase day by day: at first about 1 teaspoon to ½ fl oz (5–15 ml), by day 3 about ½–1 fl oz (15–30 ml) per feeding. On days 4–7, it’s usually 1–2 fl oz (30–60 ml) per feeding, often with 8–12 feedings in 24 hours.

The amounts per bottle in the chart are guide ranges, not rules. Over time, bottles get bigger and feedings less frequent: toward the end of the first month, many babies drink about every 3–4 hours; at 2–4 months, usually 5–7 feedings a day; at 4–6 months, about 4–6. From 6–12 months, that’s initially 4–5 milk feeds, and with three solid meals a day, just 1–2.

Many parents hope a certain formula might make nights calmer. Understandably so, when you’re getting up for the fourth time at 3 a.m. Honestly, though: there is no type that has been proven to make babies sleep through the night. It’s normal for babies to wake several times at night in the first months, and many still need one or more feeds overnight until about 6 months. In a Canadian study, at 6 months more than a third of babies still were not sleeping 6 hours straight, and at 12 months more than a quarter still weren’t; at 6 months, more than half still were not managing 8 hours in a row.

• No cereal or puree in the bottle: Drinkable porridges, meal-in-a-bottle products, and so-called bedtime bottles are not suitable for babies, according to public health guidance. Puree belongs on a spoon. From a bottle, a baby can easily get too much, can choke on thick food, and their teeth suffer.

• No flakes, no sugar, no honey: Cereal flakes, sugar, or honey do not belong in a milk bottle. Only if a doctor explicitly advises thickening for reflux does something different apply.

• Never leave your baby alone with a bottle: Never prop the bottle on a pillow so your baby can drink alone, and don’t leave your baby in bed with a bottle. Your baby can choke on the milk.

• No constant sucking: If your baby constantly sucks on a bottle, once teeth come in they are continuously bathed in milk sugar. That promotes cavities.

A practical nighttime setup: have a bottle ready with the powder already portioned, and a thermos with boiled water, as described above. Keep feeds calm and quiet, without playing, and after burping put your baby back in bed. That helps the night stay night—for both of you.

At some point—in Germany, the guidance is between the beginning of month 5 and the beginning of month 7—your baby will show signs of being ready for a spoon. They can hold their head up, sit upright with a little help, and are interested in your food. They no longer automatically push puree back out with the tongue. Even so, milk remains the most important source of nutrition and fluids throughout the whole first year. Here’s how the bottle changes over time:

• With each full solid meal, one milk feeding drops away. The remaining milk feeds stay bottles of your usual infant formula.

• In the German feeding plan, milk-cereal porridge can be made with up to about 7 fl oz (200 mL) of cow’s milk a day, or with the infant formula you already use.

• With solid meals, gradually offer a little water from an open cup.

• Between the tenth and twelfth month, your child increasingly joins family meals. Then they can drink cow’s milk with meals from a cup, about one glass at breakfast and one at dinner. By then, drinking milk should no longer come from a bottle.

• In Germany, toddlers are recommended to have 3 servings of milk or dairy products a day. Special toddler milk is not necessary for that.

Around the first birthday, bottle time can slowly wind down. Infant formula has done its job all the way to the end—without any need for follow-on or toddler formula.