Consider the sensation of being a first-time parent trying to choose an infant formula at the grocery store. The sheer number of options is… overwhelming.
Before we get into the differences between standard infant formulas, let’s first talk about their similarities. Among the many requirements for infant formulas, the FDA specifies 30 nutrients that must be included. There are minimum amounts for all 30 nutrients and maximum amounts for 10 of these nutrients. In addition, all ingredients used must be safe and suitable for use; however, there is no standardization for additional ingredients (e.g., prebiotics), which companies often utilize to more closely mimic breastmilk.
The North American Society For Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) provides categories of formulas by protein type for premature and term infants, as well as children older than 12 months of age. According to NASPGHAN, formulas within each category are comparable and safe to substitute for one other, which is particularly relevant during infant formula shortages. The most common formula type is standard infant formula made with cow’s milk protein, for which NASPGHAN lists 112 (112!!) options on the US market that are comparable to one another and safe to interchange (e.g., Enfamil, Similac, Good Start, etc.)
Other categories (separate from the above 112) include amino acid-based (e.g., Elecare, Neocate), extensively hydrolyzed / hypoallergenic (e.g., Nutramigen, Alimentum), soy (e.g., Prosobee), premature (e.g., Neosure), and toddler formulas.
Let’s consider Similac’s standard infant formulas made with cow’s milk protein, most of which come in both powder and “ready to feed” liquid forms. Of these, NASPGHAN says the following 8 formulas from Similac are comparable: Similac Advance, Pro Advance, Sensitive, Pro Sensitive, Total Comfort, Pro Total Comfort, 360 Total Care, and 360 Total Care Sensitive. So many products from a single company—what are the differences between them?
- “Pro” formulations use non-GMO (genetically modified organism) sources and have different prebiotics from their counterparts. For example, Similac Pro Advance uses non-GMO sources whereas Similac Advance may include ingredients from GMO sources; each has a different prebiotic.
- Prebiotics are non-digestible carbohydrates that stimulate the growth/function of gut bacteria.
- Per Similac’s website, Similac Sensitive and Total Comfort are “milk-based formulas for infants with fussiness and gas due to lactose sensitivity” (not to be confused with lactose intolerance). In contrast to Similac Advance (primary ingredients: milk, lactose, and whey protein concentrate), Similac Sensitive’s primary ingredients are corn syrup and milk-protein isolate; Total Comfort’s primary ingredients are corn maltodextrin and whey protein hydrolysate.
- 360 Total Care contains similar ingredients as Similac Advance with the addition of 5 human milk oligosaccharide (HMO) prebiotics, which are manufactured to mimic 5 of the most common HMOs in breastmilk. Similac markets 360 Total Care as “our closest formula to breastmilk”. Accordingly, 360 Total Care and 360 Total Care Sensitive are the most expensive products among the above options from Similac.
Another confusing issue from a marketing perspective is a company’s claims that a formula’s ingredients specifically benefit infants’ brain development, immunity, growth, etc. The majority of these claims appear to be poorly substantiated and may be used by companies simply to inflate prices.