Breastfeeding is the best way to feed your baby, but sometimes it's not possible. If you can't breastfeed or use expressed breast milk, use an infant formula until your baby is 12 months old. When prepared cleanly and correctly, infant formula is a safe and nutritionally adequate food for a baby.
Infant formula products
There are a number of infant formula products available in New Zealand that have been developed to contain similar nutrition to breast milk. All commercial infant formulas in New Zealand have to meet strict food safety standards to ensure they are safe for your baby. Follow the directions on the label carefully to make sure you are preparing them properly.
One of the main differences between the types of formula is the protein in them, such as cows’ milk-based formula or soy-based formula.
Cows’ milk-based formula
Cows' milk infant formula is the most commonly used and widely available infant formula in Aotearoa New Zealand. Most babies tolerate a cows’ milk formula. When choosing an infant formula, use one that’s right for your baby’s age. Your baby could become ill if you feed them a formula intended for older babies.
Soy-based infant formula
Soy infant formula is made from soy beans, not cows’ milk. Soy formula is an option for some infants over 6 months of age who have cows’ milk allergy (CMA). Soy formula is not for:
- babies aged under 6 months, because of concern about developing allergy to soy
- babies who have a severe allergy to cows' milk.
Soy infant formula must not be confused with regular soy milk, which does not provide suitable nutrition for babies. Read more about infant formula for cow's milk allergy.
Partially hydrolysed formula
Cows’ milk contains 2 types of protein, casein and whey. Babies with CMA may be allergic to one or both of these proteins. In partially hydrolysed formula, the cows’ milk protein has been only partially broken down so can still cause an allergic reaction in infants with CMA.
Examples of partially hydrolysed formula include Karicare HA and Nan HA Gold Protect. Read more about infant formula for cows' milk allergy.
Extensively hydrolysed formula
In extensively hydrolysed formula, the cows’ milk proteins have been broken down by enzymes into very small particles called peptides. The extensively hydrolysed formulae currently funded in New Zealand are Aptamil® Gold+ Pepti Junior, Aptamil® AllerPro SYNEO™ 1 and Aptamil® AllerPro SYNEO™.
Extensively hydrolysed formula is an option for most babies with CMA. Some infants with CMA who are very sensitive will react to Pepti-Junior and require an amino acid formula. Read more about infant formula for cows’ milk allergy.
Amino acid formula
Amino acids are the simplest form of protein and are very easy for your body to digest. Amino acids form the building blocks for protein. Examples of amino acid formulae funded in New Zealand are Elecare (Abbott) and Neocate (SHS Nutricia). These are used for babies with severe CMA. Read more about infant formula for cows’ milk allergy.
Lactose-free infant formula
Lactose is a sugar (carbohydrate) found in cows’, goats’ and sheep milk. Lactose-free formulas are usually cows' milk formula with the lactose removed and replaced with an alternative carbohydrate source. Lactose-free formula is an option for formula-fed infants with lactose intolerance. Soy formula is another lactose-free option.
Lactose intolerance is rare in babies. If you suspect your baby has lactose intolerance, see your doctor before starting a lactose-free formula. A lactose-free formula is not an appropriate treatment for CMA. Read more about cows’ milk allergy or lactose intolerance.
Anti-reﬂux infant formula
Some infant formulas are marketed as anti-reflux. These often have ‘AR’ or ‘reflux’ in their name. Examples of anti-reflux infant formula are Aptamil Gold AR, Karicare AR and Novalac Reflux.
These formulas have thickeners that are designed to stay in your baby’s stomach, reducing regurgitation. Different anti-reflux formulas contain different thickeners.
Before you start your baby on anti-reﬂux infant formula, it's important to talk to your midwife, doctor or pharmacist to ensure that this is the best option for your baby. Read more about reflux in infants and children.
Homemade infant formula
A number of homemade infant formula recipes are spreading online. There is no guarantee that these are safe or nutritious enough to give to your baby.
Homemade infant formulas may not provide the right nutrients for a baby. They might also contain unsafe ingredients or could be prepared in a way that allows harmful bacteria to grow. This can lead to serious illness or even death. Do not use homemade infant formula to feed your baby.
Whole cows' milk is not suitable for babies under 12 months. Use breast milk or infant formula as the main drink until your baby is 1 year old. Babies fed cows' milk before 1 year of age are at increased risk of having low iron.
After 1 year, most children can drink cows’ milk. Homogenised milk (that comes with the dark-blue lid) is the best type of cows’ milk for toddlers. Lighter, reduced-fat milks don't have enough fat for them. You can consider other milks after your child's second birthday.
Goat’s milk, sheep milk, mare’s milk
These aren’t suitable as drinks for babies under 1 year old because, like cows’ milk, they don't contain enough iron and other nutrients babies this age need. As long as they're pasteurised, they can be used after your baby is 1 year old.
These animal milks are not suitable for children with CMA as the proteins are very similar to those in cows' milk and most will react to these too.
Rice milk is lower in energy, protein and fat. Rice milk is not recommended for children under 5 years of age as the sole milk replacement.
Oat milk, almond milk, cashew nut milk and coconut milk
These milks are lower in energy, protein and fat but some may be fortified with calcium and B vitamins. They are not recommended for children under 2 years of age as the only milk replacement.
- Food and nutrition guidelines for healthy infants and toddlers Ministry of Health, NZ, 2021
- Managing cows’ milk protein allergy in infants BPAC, NZ, 2019
- Soy infant formula National Institute of Environmental Health Sciences, US
- Homemade infant formula Ministry of Health, NZ
Information for healthcare providers
Infant formula algorithm The Paediatric Society of NZ and NZ Child & Youth Clinical Network, 2020
Soy infant formula FAQ The Paediatric Society of NZ and NZ Child & Youth Clinical Network, NZ, 2020
Appropriate prescribing of amino acid formula in infants with cows' milk protein allergy BPAC, NZ, 2020
Managing cows' milk protein allergy in infants BPAC, NZ, 2021
Allergy to cows' milk protein and the appropriate use of infant formula BPAC, NZ, 2011
Cow's milk allergy in infants Goodfellow Unit, NZ, 2020