Changing Formula and the “Formula Shuffle”

Changing Formula and the “Formula Shuffle”

Babies will often require a formula change, or even several changes. This is NOT a drawback to formula feeding and it does not mean that formula is “bad” or “not meant” for babies.

The need to modify your baby’s formula is as common as a breastfeeding mom’s need to modify her diet, which may include – drinking more water, taking vitamin or supply-boosting supplements, avoiding raw veggies, spicy foods and caffeine, cutting back on the garlic, or limiting dairy products – as many seemingly innocent foods can sometimes upset the digestion of a breastfed baby.

Not every breastfed baby will require mom to modify her diet, just like not every formula fed baby will require a formula switch. But just like how some breastfeeding moms need to make extensive diet modifications, some formula fed babies will require extensively modified formulas. This is not novel. However, what we often see and provide consultations for is a problem we dub – the formula shuffle.

The formula shuffle occurs when health care providers, most often pediatricians, are presented with babies whose caregivers are reporting clear signs that their formula is not being tolerated well. What are the signs?

–          Frequent spitting-up

–          Slow to gain weight or failure to gain weight

–          Crying during and/or after the feeding

–          Excess gas

–          Bloated belly

–          Unsettledness after the feeding (inability to be put down or nap peacefully in between feeds)

–          Excessive soiled diapers

–          Too few soiled diapers

–          Loose stool

–          Blood in stool

–          Skin and/or diaper rash

–          Persistent cough or wheezing (in the case of a milk allergy)

Most caregivers’ first stop when a baby is exhibiting such symptoms is their pediatrician. Unfortunately, pediatricians often give some of the worst formula recommendations in these situations.

Consider this: if a breastfeeding mom presents in the office with feeding difficulties, she is referred to the feeding “expert” – the in-office lactation consultant, which most pediatric offices now staff or at least hold community affiliations with. But when a digestively troubled formula fed baby presents, the pediatrician has no expert on staff and defaults to making his or her own recommendations.

Caregivers get told to go buy “X” formula, because it should do “Z,” and to give it a few days and call back. Well, the caregivers are the ones who have to go home to the agony of a failed recommendation (which is often inappropriate in the first place), and often more and more failed recommendations after that.

While certainly well-intentioned, these recommendations are rarely tailored to the specific baby presenting, because the pediatrician does not have the time or hands-on expertise to go on a fact-finding mission to gather specifics about all of baby’s feeding behaviors and how they could be influencing the situation.

They are familiar with the dominant formulas on the market and when they *could* be indicated, but picking apart an intolerance from an allergy, knowing the time and place for low lactose formula, knowing the effects of whey protein – or how feeding position modification, burping technique and bottle changes can fix what presents like a “formula problem” – this stuff is just poorly understood and massively overlooked. And so, the baby and caregivers start the formula shuffle.

A Common Formula Shuffle Scenario

1-          Baby presents with difficulty feeding, constant fussiness, inability to be put down, difficulty resting, and spitting up.

2-          With no testing of any sort, the pediatrician jumps over a trial of hydrolyzed formula (i.e. Enfamil Gentlease) and goes right to recommending outrageously expensive Enfamil Nutramigen or Similac Alimentum, which are elemental formulas designed for babies with milk allergies (not intolerances). Caregivers stress over the cost but dedicate themselves to purchasing this product that should make their baby well again.

3-          The formula switch yields no real results. Baby is still exhibiting most if not all symptoms.

4-          Next, the pediatrician starts to talk about a possible milk allergy. Why an allergy is discussed AFTER placing baby on a hypoallergenic formula is beyond me, but it happens all the time. Caregivers are given options for objective allergy tests to confirm the suspicion. (These tests are helpful BEFORE one starts paying for an elemental formula.)

5-          The baby’s tests come back and he does not have an allergy.

6-          The pediatrician now tells the caregivers that the elemental formula originally suggested might actually be causing digestive upset, and to give it 7 to 10 days to get out of baby’s system.

7-          An array of recommendations for soy formula, prebiotic formula or even gentle formula now ensues – each taking about a week to “try it out” and each fail. Precious time is wasted and a household is in upset.


So, let me tell you how this above scenario almost always ends – reflux. Ninety-percent of the time the infant is experiencing no formula issues whatsoever, but rather reflux, which can mimic a formula issue but is not remedied with elemental formula.

In these cases, using an A.R. (added rice) formula, or manually thickening the formula of your choice; feeding upright; maintaining uprightness for 20 minutes after a feeding; frequent burping; using a gas-friendly bottle; implementing a specific feeding schedule; an inclined sleeping position; and discussing reflux medication options with your pediatrician – can all make a world of difference. Caregivers go on months-long painful excursions seeking formula remedies and they were never necessary to begin with.

So, if you’re currently exhausted from the formula shuffle and a series of failed formula recommendations, and need help accurately pinpointing what is going on with your baby and what steps can be taken to benefit her, please contact us now!

No Comments

Post a Comment