EP 15: How to Choose Baby Formula: 3 Step Framework for Parents

Overwhelmed by the formula aisle? Dr. Liz Daniels, pediatrician and registered dietitian, shares her practical 3-step framework for choosing baby formula with confidence. This episode cuts through the conflicting advice to help you understand what really matters when selecting formula for your baby.

What You'll Learn

• The 3-Step Framework: How to evaluate any formula using Dr. Liz's clinical decision-making process
• Understanding Breast Milk: What's actually in breast milk and how formulas compare
• Decoding Labels: What to look for in carbohydrates, proteins, and fats on formula labels
• When to Switch: How to know if your current formula is working or if adjustments are needed
• Cost vs. Quality: Why expensive doesn't necessarily mean better

Key Takeaways

✓ All formulas on shelves in the US meet strict nutritional and safety standards
✓ Start with a standard formula (lactose-based, intact protein) unless there's a specific reason not to
✓ Aerophagia (swallowing air) can cause symptoms that mimic formula intolerance
✓ If you switch between formulas, it's safe - you won't harm your baby. But it is important to get support if symptoms aren't improving

Topics Covered

• Carbohydrates in formula: lactose vs. alternatives, HMOs (human milk oligosaccharides)
• Protein types: intact, partially hydrolyzed (gentle), extensively hydrolyzed (hypoallergenic)
• Fat sources: MFGM (milk fat globulin membrane) and palm oil considerations
• When to call your pediatrician about formula concerns
• Organic vs. non-organic formulas
• The role of probiotics and prebiotics

Referenced Episode

Episode 8: Probiotics in Infants

NEW COURSE! "Read the Pattern: Feeding Your Baby 0–4 Months" — because a healthy relationship with food starts earlier than most people think. Course Link!

Transcript

SPEAKER_00 0:00

Overwhelmed with the formula aisle? Drowning in Facebook ads and conflicting advice from friends about the best formula for your baby? I hear this all the time. And as a pediatrician who's guided thousands of families through this exact decision, I'm going to give you my three-step framework that I like to think through when I'm making decisions on what's right for the family in front of me. So if you have a baby and you're going to be using formula or you are navigating this conversation even for a friend, I would love for you to stick through to the end so that you can make this decision with confidence and clarity. Welcome to the Nutrition for the Early Years podcast with Dr. Liz, your guilt-free guidance for feeding your family. This podcast is for folks who are craving better nutrition for their kids, but are tired of the whiplash and nutrition claims of diet culture influence. You're reading labels, paying attention to ingredients, but you still doubt yourself. And for good reason, food goes deep. And often we fear making costly mistakes that, as parents, we hope to prevent. If you're ready to explore the ins and outs of your child's actual nutrition needs and nourish the whole child from the inside out, hang with me, Dr. Liz Daniels. I'm a board-certified pediatrician plus registered dietitian, and we're gonna dig deep into real-deal nutrition science, honest talk about barriers to health, and real stories that I help address. So let's dig in. Welcome back to the Nutrition for the Early Years podcast with me, your host, Dr. Liz Daniels. I am excited to talk to you today about how to choose a formula. I typically am having these conversations when families are in the two to four month stage. If a mom is either going back to work and needing some support with supplementing, if breastfeeding isn't going the direction that they want it to, or if for lots of other reasons, it's just a need. But the question usually is what formula do you recommend? So today I want to go through the framework that I use to help me decide what's really the right place to start. Because I think the bottom line is families want to know, am I making the right choice? And if you've ever been in that place where you've stood in the formula aisle, late night Google Spiral, or say you go talk to your friends and then they recommend what they're taking, and all of a sudden now you have a thousand Facebook ads on your phone. It's just overwhelming really fast because they all seem to have some claims. Everyone seems to be the closest to breast milk, and it can get really confusing really, really quickly. And so, really, what I'm gonna start off by saying is that you're not gonna mess this up. You're not. There are some really great products out there, and there's not one perfect formula. It's really not even that there's one best formula. You need to choose a starting point and then adjust based on your baby. And so I like to reframe this as where should we start? So when I'm in a clinic, the things that I start out by thinking about are sort of three primary things. And we're gonna go through these one by one. But my first question is, is this formula, fill in a blank, nutritionally complete? Because nine times out of ten, families come to me with an idea or one that they're thinking about or one that their sister used that they really liked. And so that's where I start. Is this formula nutritionally complete? And then number two, I'll say, how is this formula similar or different from breast milk? Well, for that, we need to understand breast milk, and we're gonna dive deep into that today. And then the third question is do the differences between the formula and that you're looking at and the breast milk that your baby's getting, does that difference matter or will it resolve the concern that you have? Right? And that is how we make those decisions and pivot. And I use that same framework for picking out the formula and then for pivoting if we need to adjust. And understanding those is actually really complex. I do not expect families to walk away from this podcast feeling I know everything about formula. That's not the goal today, okay? The goal is where do I start? Do I feel confident with picking something? And then what am I gonna look for? That's the goal because that's kind of my job. I would say I'm a self-proclaimed formula queen. I love talking about formulas. I think it's fascinating. I have always been interested in it. And for the record, I breastfed my kids, but I still found formulas fascinating. Because bear in mind, I'm also used to the world of tube feeds and other things well before I even was in medical school. So these kinds of conversations are really, really intriguing to me because the question becomes, how do we really understand what it is? And more recently, there's a lot of attention from families on looking at all the ingredients, but I would love to do an even deeper dive into how each one is sourced and what they are, because some of those things can actually provide nuance to the product itself and influence not only the cost but the manufacturing and the shelf stability. Oh goodness, I could talk forever about these things. I do. I really love these conversations. But I my goal when I have a family who asks me this question is to give them a simple answer or and for them to feel empowered with knowing here's what I'm looking for next. So that's my goal for you today. So before we get into the differences though, you should know that one, all formulas that are going to be on the shelf here in the US as of today of this recording, and if this is ever updated and changed, I will update this podcast. But the formulas that are on the shelf all have the same standard of number one, meeting very strict requirements for calories, protein, fat, carbohydrates, vitamins and minerals, as well as safety parameters. Now, that is continually being updated, and actually the safety requirements is something that a lot of formulas will now have a lot number on the very top, and you can look and see specific formula safety uh standards that were met for that particular can that you're offering. Even in the world of safety, we've had tremendous improvements in the last year and in the last five years especially. So I think that's really amazing, and so I feel really confident saying that if it's on the shelf and it's not expired, it's nutritionally safe and complete for your baby. However, there are a lot of nuances. So we're not really choosing between good and bad. We're gonna be choosing between different ways of delivering some of those same nutritional requirements. Because there are different ways to achieve some of those goals. Think about it though, on a really, really micro level. There are different ways to get those nutrient needs met, and formulas are going to differ, but they still will meet those same needs. Now, it's okay that they're different. And while some parents might feel like, oh my gosh, everybody claims to be the best, everybody claims to be the one product that we need, and they're all saying that they're just like breast milk. Well, here's the thing: breast milk is actually really dynamic, and it's really, really, really different from day one when you have colostrum to day 28 when you have really mature milk. It turns white for some mamas on day one, sometimes not until day seven or 10, even, but there's still a lot of maturing that the milk itself is going through. So to say that something is just like breast milk is kind of unfair because breast milk is going to really mature with the baby. And so it's not really exactly the same thing. What we can say is that it has the same nutrient profile as breast milk, or it has the same nutrition that the breast milk is going to be able to offer. But the delivery system is different. So, for example, breast milk is unique in that the milk that's coming out in the beginning of the feeding, towards the middle, towards the end of the feeding, is actually going to have a little bit different nutrients all the way through. And formula is static, right? Drop one at the beginning of the bottle to the last drop of the bottle has the same kind of consistency between the nutritional profile all the way through. And then even as the baby's maturing from month of life one to month of life 12, the breast milk matures quite a bit. And formula, again, is really static. It's hard to say that anything is just like breast milk. Companies are really truly trying to make products that are as close to breast milk as we can possibly make. But it's just important to understand that different products exist on the market for very good reasons because there are some babies who really differ in their digestive abilities and in their needs, in their maturity. Preterm babies need something different than our full-term babies. And so, to that degree, I think it's really important to recognize that when labels are making claims about being just like breast milk, or they're being they're making claims about a specific quality in the formula, it's important to understand how this formula is similar to breast milk and where does it differ. Because that is where our decisions about is this right for me is going to live. So this is where I want to segue and get into the nerdy part of this, because in order to understand those claims really, you kind of have to know what is in breast milk and why is this even on the market. Now, let's talk through the three main macronutrients in breast milk so that we can understand that in context of formula. Carbohydrates in breast milk. We'll start there. In carbohydrates, breast milk is primarily lactose, and secondarily human milk oligosaccharides. That is a long name for basically breast milk fiber. And so, what I'd like families to understand is that lactose is the main sugar that's in breast milk. Your body synthesizes it and makes it, whether or not you drink dairy. That's just what humans, that's what mammals make as the sugar source in their milk. So lactose is the primary source in formulas. If you're looking on the back of the label, if you see lactose as one of the primary ingredients, that tells you that that is the primary carbohydrate source for that formula. And that is actually the closest match to breast milk from a standard product. And this is important to know because actually most babies do really well with lactose-based formulas. Babies are born with enough enzyme lactase to break down lactose that they could handle about 800 milliliters of lactose-based milk, which is way more than they're getting in the beginning, for what it's worth, right? When we even have digestive issues, lactose isn't typically the problem. The other carbohydrate source that I mentioned is human milk oligosaccharides. HMOs are complex. There's about 200 of them characterized so far within breast milk, within human breast milk, and they are long, complex carbohydrates that do not get digested in the small intestine, and they actually serve more like prebiotics. They actually serve a lot of different roles, and they're really important for immune signaling and helping to mature the immune system in the colon. They're very important in helping grow and support gut bacteria because your baby's gut isn't sterile when they're born, but it's still immature, these types of complex carbohydrates actually really help to develop that and to diversify it. Those are really unique, and that's an active area of research right now. And some formulas are actually going to have some of these in them. They're going to be written as something a little different. So here's a little bit of the nuance. When you're looking at the labels, if you were to see anything that says oligosaccharides, those are going to be the version of what formula can offer that's close to the human milk oligosaccharides. The amount is really complicated to get just right because you could imagine all moms are going to be a little different in this. And based on your diet, based on where you live, your what's in your milk from a human milk oligosaccharide standpoint is going to vary. And the same would be true from a formula standpoint. Some formulas don't have any HMOs or any human milk oligosaccharides. Some have oligosaccharides that are derived from cow's milk. And that is that's a little different, but it's still gonna have that saccharide end of the word on there. Um, we call them goss or foss. Those are gonna be, those are gonna be some of the names that are on the label when you're looking for it. And some formulas don't have any oligosaccharides at all. And so if you are looking for, okay, what is gonna look like breast milk on the label for carbohydrates? You're looking for lactose and you're looking for oligosaccharides. Something too is that there is a purpose and there is a reason for replacing the lactose. I don't typically recommend that as a first start, but in some of the more broken down formulas, the lactose will be replaced with corn syrup solids, brown rice syrup, sometimes straight sucrose. It's important to know that these are not the same thing as high fructose corn syrup. This is not candy, this is not junk food. This is a carbohydrate source that is very easy for an immature gut to be able to break down if they need to. So it's there for a purpose. It's also shelf stable, so it will be safe for the baby in time if it has to be in a powdered form. And within that, there are specialty formulas that may actually have no corn in there at all, and maybe specifically a tapioca-based product or a brown rice product, right? There's going to be different components within that carbohydrate source as opposed to lactose if it needs to be replaced for those more specialty formulas. Just full recommendation here, those should probably be conversations with your pediatrician to help guide you because those would signal to me that your baby's digestive needs are more complex and that you need more individualized care. So, but for a standard product, lactose and HMOs. Let's switch gears and talk about protein. This is a big one clinically. Okay, so I'm gonna spend a little bit more time here, get into the weeds a little bit, so hang tight. Breast milk primarily contains two types of protein, whey and casein. And that ratio is going to change based on if you are early in the colostrum days all the way to mature milk days. So, breast milk, again, remember how we talked about it's dynamic? This is one of those areas where you're changing over time. Early milk tends to have more whey, which often can seem to be easier to digest, but may or may not, as kind of assumptions there. But so, at any rate, formulas are going to primarily also have whey and casein in the standard products. But what I want to mention about these is that it's not just one or the other, it's about the size of them. Because in human milk, breast milk, these proteins come through in the breast milk intact. You ever seen those rubber band balls where it's like all the different colors of rubber band balls all together? And you know, you can take one rubber band off at a time and the colors kind of come off in pieces. I like to think and picture these proteins like that. Proteins are globulins of all of these amino acids sort of bound together and stuck together. And our digestive enzymes will reach the surrounding edges of them and try to break off little pieces like a rubber band one at a time. And it eventually gets smaller and smaller until it's little peptides that we can then fully absorb. And breast milk is going to have intact proteins, both for whey and for casein. And within that, most babies do just fine breaking those down. We're built with a fair amount of digestive enzymes already ready to go in the small intestine. However, some babies' guts are still really immature and need more support, or are slower to get all of those digestive abilities there. Our liver is still working to come online when we're born, our pancreas is still working to get some of those digestive enzymes ready to go. And some of that really isn't like close to adults until we're a year old, meaning that by six months, most kids have pretty mature guts. But sometimes it's taking a really long time, and especially in the very beginning, if your baby is really, really struggling with digestion, this is where a lot of the clinical decision making begins for your pediatrician to think about are we doing okay on an intact protein? And do we need to break this down? And I do think that a whole different podcast needs to be devoted to something called calmic protein allergy because it's it's in this realm where we use formulas specially specialty for calmic protein allergy or calmic hypersensitivity. There's a lot of different ways people kind of talk about this, but what I want to say today is that the formulas that I typically start out with are gonna be what's close to breast milk. Let's go with an intact protein. On your label, that's gonna be whey concentrate, okay? Or it'll say whey and it'll say casein, and they're gonna use the word concentrate primarily. And then as it gets partially broken down, they can with heat and some enzymes break some of these proteins down into smaller rubber bands, per se. And then that's gonna be called partially hydrolyzed. The kind of marketing term for that is gentle, and that one is gonna be commonly used to like market towards like colic or gas and spit-up and reflux symptoms. And that's okay to go with, but I think it's important for families to understand that what you're switching is the size of the protein. And some babies do really well with that, and for some babies, it actually is not fixing the problem. But this is the area where I tend to spend more time trying to sift through what are the symptoms that my baby's actually experiencing to know if this change in the formula is really gonna be helpful or if it's not gonna be helpful. And the time it takes to get from your mouth to your large intestine is about 10 hours. So we're gonna start seeing if this is truly a you know protein issue, we're gonna start seeing improvements in those formula differences, usually within the first day, if that's really gonna be the solution. Okay, so you have your intact protein, you have your partially hydrolyzed, your gentle formulas, and then even further broken down are your extensively hydrolyzed. These are also called hypoallergenic. And just quick side note, this is not the same thing as like a peanut allergy or you know, a food allergy where you get anaphylaxis. This is a very different conversation. Again, that's a whole camel protein allergy conversation for another podcast. But again, that's also where I would probably pull in your pediatrician because you really do want to get some supervision and guidance on that. The more broken down your formula is gonna be for the protein is gonna be, the easier it's gonna be for that baby to absorb that nutrition. But that also means it's gonna be more processed and also more expensive. When you're looking on the label, that will say things like instead of whey concentrate, it'll say things like hydrosylate or isolate. Those are the terms that are gonna be used to indicate that it's been more further broken down. Often, when you have a formula that is a gentle formula or it's partially broken down, a lot of times the manufacturers go ahead and replace the carbohydrate source too. And with that, they're going from a lactose to a corn syrup solids carbohydrate source. And to me, that's changing two variables. There's one product on the market that is lactose with a partially hydrolyzed protein structure, but most of them are gonna change both of those things. However, it's usually the protein that is gonna be the target in terms of clinical intervention. So, what this means for you is that if your baby is really struggling with things like gas and fussiness and like really arching their back and they're in a ton of pain, I do think that that's typically where families go next, with or without our advice, and that's okay, and that's part of the purpose of this podcast, to try and see if that adjustment can make an improvement for your baby. And again, if you're gonna notice a difference, you're gonna notice pretty quickly. If you're not noticing a difference and it's been some time, this is definitely time to call in your pediatrician and make sure that we're treating the right symptom. There's also whey and casein in cow milk. However, the actual structures of the whey components and the types of the casein components are actually different because they're human. If we break this down a little further, a couple different types of casein structures. There's an alpha, there's a beta. Within the beta, there's actually two types of that. Humans produce primarily something called an A2 casein protein. And I want to mention that because you'll see sometimes formulas that are going to say A2 and goat milk products are going to be primarily A2. And for reference, most cow casein is A1, unless it's been bred specifically to be A2. And the reason this is relevant is that while it's an intact protein, okay, so not hydrolyzed, not broken down, it's intact. It actually is in a shape that allows the digestive enzymes to efficiently break it into smaller pieces. On its own. So just the shape of it allows our digestive enzymes to be pretty efficient. And for some people, that results in fewer gas, bloating, discomfort. And so some people really prefer those products. And so, you know, I mention it because it's it's out there and there is a role for it. Not everybody needs that, but that is still considered an intact protein source. So this would not be a reliable source for somebody who truly has like calm proteinology. Again, that deserves a whole other podcast. But I just like to mention it because I get the question often. Let's shift gears and talk about the breast milk fat. Because this, you guys, is like so cool. And it's where breast milk is uniquely efficient. So I want to talk a little bit about something called milk fat globule membrane. Now there is in the breast tissue, in your mammary gland, in the milk ducts, your breast tissue, when you're breastfeeding, produces these little droplets of fat. And they have this little kind of envelope on the outside. And that envelope kind of holds in all of the fat in the inside. And this is really important because baby's digestive enzymes, specifically pancreatic lipase, that breaks down fat, it's not really working great yet. And so, in order to digest fat, the baby really needs a way to just straight absorb it. And this little package, this little envelope of fat droplet, can slip right inside the cell wall, and the baby can absorb that fat really quickly and efficiently. And that's important because fat is used for laying down and coating and protecting nerves, so helping brain development. It's really important for our skin and our barrier. It's really important for our gut health. It's really important for growing and tissues and all of the energy that it takes to grow. So MFGM for short, or milk-fat globule membrane, helps with fat absorption. And you'll see on some labels MFGM. Or if you have a whole milk formula, it's going to have MFGM from the cow milk because it's in the whole milk, like the fat part of the whole milk. This is also important because the on the inside of that envelope within breast milk is a very special type of fat that is unique to humans. It's called palmitic acid. And palm oil and palmitic acid exists in animal sources as well, but how it's digested is unique to humans. So this particular type of palmitic acid actually is important for babies, and it's part of the reason that breastfed babies have such seedy poop and they tend to have that soft and some like sweeter kind of smelling poop than formula. And the difference comes down to the oil construction. So in vegetable oil blends, which are safe to use for babies and it's totally safe in formulas, and it does get absorbed, it just is a little bit different in its absorption process because you do have to rely on some digestive enzymes. And so the point of saying this is that the little envelope that breast milk fat is carried in is unique to humans and it's unique to breast milk. And this particular delivery method is really a great way for our breastfed babies to grow. And I think that's actually a big part of what we think leads to some of the other studies that we've looked at from the benefits of breast milk, right? So when we think about how breastfed babies have potentially higher IQ or potentially have lower risk for infection, potentially have, you know, decreased risk for obesity and metabolic diseases as we age, we actually think that it has something to do more with this particular part of the breast milk. Again, active research, really, really interesting. And what this means for you though is that like within formulas, really and truly, most babies are going to tolerate standard oil blends in their formulas just fine. Like they really do grow beautifully on it. And when you see a label that says no palm oil, there's some chemistry to go into on that, and happy to do it if you have questions. But the the main through line here is that if it says no palm oil, the purpose in saying that is to allude to the outcome of softer stools. So if you have a baby who is having really hard stools on formula and they do have a palm oil in there, that is one area that we might be able to adjust the formula a little bit to see if we affect a change. So know that these differences exist. Know that it's okay to tolerate a standard fat blend of like an oil blend, and that if you wanted to add MFGM or you wanted a formula that had MFGM, that would be fine. So here's the other caveat to this. Are you using formula for one bottle a day? Or are you using formula exclusively? Right? Like if I have a family who is just supplementing a little bit or temporarily with formula, I may not suggest a super expensive product because it's short term and the baby might be breastfed anyway, right? And we're just looking for something that's a quick, like a close, a closest we can get kind of replacement during that time period that's going to be nutritionally adequate. If my baby is struggling on breast milk and we are not getting either enough nutrition and we need to add more nutrition in there, if we're struggling with stooling or we're struggling with our digestion in a particular way, this lens helps me zone in on what kind of levers I want to adjust in order to help support that baby better. And I hope it helps you too. So let's put this all together and let's bring this back to real life. You have a baby and you need formula. Where do you start? Well, if your baby is growing well and they were on breast milk, then you'd start with a standard formula. So you'd start with something that has lactose as a carbohydrate source, an intact protein as your protein source because it's gonna meet your nutritional needs and it's gonna give you a clear baseline. And then you watch your baby. Okay, you look and see what's happening. Did they take it? Are they growing? And are stools okay? Are you comfortable between feeds? Are we are we doing okay in between? Then you're done. And there's no more guesswork, and you just continue and everything is fine. And you know, if something feels off, if we are having trouble with digestion, we go back to the framework and we say, okay, what are the symptoms and how does that lead me to adjusting the formula? Typically, I'm gonna be adjusting the protein. I will think about if this needs to be a hydrolyzed product, and if so, is gentle enough, like the partially hydrolyzed, or do we need to go to a fully hydrolyzed product? If I have a family who's like, okay, well, I do that and now we're better on the partially hydrolyzed formula, then that's that's great. You have an answer, you know that the protein was really what was the challenge for them. And it's okay to revisit a standard formula as that baby matures, because if it was the protein, it is possible that as they get older their digestive capability is going to mature and they're gonna be able to go back to a standard product. So this is a question that sometimes I get of like, okay, well, we tried this product and they did really well on it. Now I'm wondering, do I have to stay on it for the rest of my life? Or what if I run out and I can't get it at the store or we're on vacation and that store that I go to is out of the formula. Can I get something else? Is it gonna be okay? Is it safe to go back? And families get really worried about switching formulas, thinking that they're gonna create a problem for their baby. And again, it would be a problem if it was not nutritionally complete. Meaning, if we gave watered down formula, diluted formula, that would be unsafe. That would be a problem. If we gave formula with unsafe water, that would be a problem. That would be unsafe. If we're going from, and I'm gonna use brand names because it's easier to understand, if we are on a Similec and we need to go to an infamil, or we are in an infomil and we need to go to a Similec, that's not necessarily, that's not gonna be unsafe. Those are gonna be safe products to go to. If we are on, you know, a standard product and you want to try out a partially hydrolyzed or even a hydrolyzed formula, those are not unsafe things to do, but I do think it's important to bring your pediatrician into those conversations because there are things that your pediatrician would want to know about why and what's going on, because there can be some nuances there. And there can be reasons for adjusting, and then what we learn about how the baby does is also equally important. So just notice those observations and then share that information with your pediatrician to be able to make the most individualized and informed decision for you. So the improvements could be multifactorial, not just one ingredient. And then to that degree, I also want to talk a little bit about Aerophagia because this is something that doesn't, I don't think, get any conversation, but is really important. If the latch is poor, or there's a really deep tongue tie, or there's some type of oral motor skill that's struggling, and we are latching off and on and off and on from either the breast or the bottle nipple, and we're taking in air as we are feeding. The baby swallows air, their belly gets distended, and then they spit up, or they have digestive issues simply from air. So we can have arophagia that contributes to a lot of the symptoms the babies might be experiencing, and it have nothing to do with a formula. Crazy, right? And so the mechanics of how the baby is feeding is different from how the baby is actually breaking the nutrition down in their body and absorbing it. But the symptoms can overlap and it can be really confusing. So if you're in that, you know, crying baby at two in the morning and you can't get them to calm down and you are over it and you are stressed, just take a breath and know that like it is sometimes really hard to turn to figure these things out. It's okay to get help. It's okay to go to your pediatrician three or four or as many times as you need when your baby is struggling, because this is how we understand you and what's going on. And you could have five babies and all have be perfectly healthy and fine and no problem, and all of a sudden your sixth baby have difficulty with digestion. And I see this often where somebody's like, Well, this never happened with my other kids, and so they get really worried, and it can still be normal, it can still be normal to spit up, it can still be normal to spit up a lot. I had the most spitty babies ever. We had like towels all over our couches and furniture for like nine months because they just puked all the time, and it wasn't a dairy allergy, and it wasn't anything, they just spit up a lot. It was a mechanics issue, and so you know, sometimes it just takes a like several appointments to get to the bottom of some of these things. And I like you to know that ahead of time so that you don't get frustrated if you feel like you don't get the right answer right away. Like this is a part of a learning process, and you're still learning your baby, and we're learning your baby with you. So don't feel like you have to like have it all figured out. It's okay. With Aerophasia, for what it's worth, actually that does tend to get better in time. It does, it also is something where additional support of lactation consultant or sometimes occupational therapy can be really helpful. Not every baby needs to get a clipping, not every baby needs to get the tongue tie release. This is again a whole thing, but the mechanics can play into the symptoms that you're experiencing, and I think that's a really important thing to be aware of. Okay, so let's talk briefly about cost because formula can get really expensive really, really quickly, and I want to be very clear that more expensive formula doesn't necessarily mean it's better for your baby. It doesn't necessarily mean it's higher quality, it doesn't necessarily mean it's safer, it doesn't necessarily mean that your baby is going to be have a better immune system because it's more expensive. The cost often will reflect the processing, like how much work does it take to create a hydrolyzed or partially hydrolyzed formula? It'll inf it'll be reflective of the marketing and the sourcing if there's shipping differences or distribution differences because maybe it's made out of the US, or you know, like maybe that the milk is initially sourced out of the US and then distributed here in the US. And those are going to be different too. But if your baby's doing really well on a standard formula, there's no reason to escalate the cost. And I think that's really important. I have some families who really want organic only, and if you choose that, that's your choice. That's okay. If you don't, that's also okay. I don't currently have any literature to tell me. Hot take, I know, I don't have any literature to tell me that organic formula is superior to non-organic formula. If I do, that will change my statement and I will update this podcast. That said, I also think it's okay to have products that reflect different preferences. And that's fine, totally fine. Know that so far I haven't addressed symbiotics, which are prebiotics and probiotics, okay? These are also in some formulas, and there are some, well, I I address the prebiotics in the form of HMOs or human milk oligosaccharides, but what I didn't mention yet is that some formulas are going to have probiotics in them as well. And that can be useful. It's not actually right now a requirement or an expectation for it to be in most formulas, but it's relevant to know that breast milk actually does have probiotics in it. That said, if your baby is on formula and you want to add it in, again, a conversation to have with your pediatrician. Or if you're curious, go ahead and take a listen to episode eight where I talk about probiotics in infants. So here's what matters. Our growth really matters. The trajectory of our growth matters, our digestion matters, how you're sleeping, how you're eating, the whole thing matters together. It's not so much about finding the perfect formula as much as it is about finding where to start. And it's about your feeding relationship and what you feel good about feeding your baby, and that's really important to me. So if I have a family that asks me what formula should I choose, I'm going to be asking them a lot of these questions because I want to know their preferences too. That plays into my recommendation. If you'd been a fly on the wall in my in my rooms, you'd see me recommend a lot of different products to a lot of different families because it's really a personalized decision. So formula companies really aren't trying to confuse you. They are responding to different digestive needs, different family situations and preferences. And this is an evolving process. There's always something new to add because there's new things we're learning about breast milk, and we want that. So, you know, it's about understanding your starting point, watching your baby, and adjusting with intention, knowing what you're trying to address. So, in closing, just start simple. Think about what's happening right now for you and your baby, what your goals are, what your needs are, and how long you're gonna be on this formula train for. I hope this framework gives you the confidence to make the best decision for your family without the overwhelm because you're just gonna get started and then go from there. Before you go, I want to invite you to join my newsletter. Every week I send out practical tips, evidence-based insights, and honestly, just things that I think will make your life a little bit easier as a parent. Sometimes exclusive coupons, sometimes it's a laugh, sometimes it's a resource that I found and I just want to share it with you. Think of it as having a pediatrician in your inbox just cheering you on. You can sign up at the link in the show notes. I'd love to have you there. Thanks so much for listening. I'll see you next time on the Nutrition for the Earliers podcast. Take care.