Baby Formula Feeding Problems & Concerns

What is infant formula?

Infant formula is specially designed to provide babies with essential nutrients, when breast milk is not available. It is formulated to provide essential nutrients that babies need for healthy growth and development. Breast milk provides the best start for babies.  But, we know optimal breastfeeding is not always possible for every family. In Australia it’s important to recognise that formula feeding is the only safe alternative to breast milk until 12 months of age.

There are many reasons why parents may choose to use infant formula for their baby, including:

• Breastfeeding difficulties: Concerns about low milk supply or other health conditions that affect milk supply or breastfeeding.
• Family and social circumstances: Diverse families, sharing feeding responsibilities, availability of support and social circumstances  may also influence the decision to use infant formula.
• Medical reasons: Some mothers may have health issues that prevent them from breastfeeding and, in some instances, formula feeding is recommended for health and medical reasons.
• Personal preference: Some parents may simply prefer to use formula for various personal or lifestyle reasons.
• Work circumstances: Parents may decide to introduce infant formula on returning to work or if they do shift work.
• Multiple births: Some parents may also choose to use infant formula in the case of multiple births, due to the demands of feeding multiple infants over time.

For more information and understanding of what goes into infant formula, you can refer to our guides on Baby formula ingredients and the Guide to baby formula.

What are the different types of infant formula?

All brands and types of infant formula in Australia meet strict requirements under Food Standards. However not all infant formulas are the same, and it is important to understand that not every formula will be suitable for every infant. Some infant formulas have different nutrient levels, protein sources, additional ingredients and differences in tastes. Some formulas are specially designed for special medical purposes (such as allergies or intolerances) and require use under medical supervision. This is why there are different types of infant formula available, allowing parents to find the best match for their baby's preferences and nutritional requirements. A healthcare professional is the best person to talk to regarding which infant formula is best for your baby. Some different types of infant formula include:

Cow’s-milk based baby formulas

These formulas use cow’s milk as their source of protein. Most infant formulas available in Australia are cow’s milk based.

Soy-based baby formulas

Soy-based baby formulas are made from soy protein. Some families may choose this as a dairy-free or vegan alternative. Soy infant formulas are generally not recommended for infants, especially under 6 months of age, unless there are unique circumstances where there is no alternative option. Soy-based baby formulas are not a recommended alternative for preterm infants or infants with a cow’s milk protein allergy.

Hydrolysed baby formulas

These formulas use proteins that have been broken down into smaller pieces. Extensively hydrolysed and Amino Acid based formulas may be recommended by a doctor when an infant is diagnosed with a cow’s milk protein allergy.

Specialised baby formulas

There are many special baby formulas that address unique medical conditions, such as metabolic disorders, prematurity, or the dietary management of reflux or lactose intolerance. These formulas are designed for infants with specific dietary needs that regular formulas cannot meet. They are not suitable for general use and should be used under medical supervision.

How to choose an infant formula

Choosing the right infant formula can feel overwhelming for parents. It’s completely normal to feel uncertain about which option will best suit your baby’s needs. Your healthcare professional is the best person to speak to if you are unsure about the best infant formula option for your baby. Factors that you and your healthcare professional may take into consideration when choosing an infant formula can include:

• Age appropriateness: Infant formulas are designed for specific age groups. Ensure that the formula you choose is suitable for your baby's age.
• Type of formula: There are different formulas to suit different dietary needs of infants, including some that are prescribed by doctors for allergies and intolerances.

Cost and availability: Prices can vary significantly between brands and types of formula. Consider your budget and what is readily available in your area to ensure you can consistently provide the chosen formula for your baby.

How to transition to a new formula

Transitioning to a new formula can sometimes cause babies to fuss or show signs of discomfort. This is quite common and often part of the adjustment process. With patience and time, along with a gentle approach, most babies will adapt to their new formula. It’s okay to seek support and take things one day at a time as you find the best feeding solution for your little one.

Tips for transitioning

• Always follow the preparation instructions on the tin of formula you are using, including only using the scoop enclosed.
• Introduce the new formula gradually, alternating between existing and new formula;
• Don’t mix existing with new formula in the same bottle;
• Transitioning morning feed first and monitor tolerance;
• Give your baby time to adapt, it make take up to two weeks.

Common formula feeding problems during feeding

Babies can sometimes fuss or struggle during bottle feeding.    . If a formula doesn't suit a baby, they may refuse to drink it or show signs of discomfort, making feeding time a challenge for both the baby and the parents. It's essential for parents to seek healthcare professional insight when starting infant formula or when changing to a different   infant formula due to concerns about tolerance issues.

Bottle refusal

Feeding your baby from a bottle for the first time doesn’te always happen easily. Suckling from an artificial teat is different from suckling from the breast, so your baby may need to learn how to do this. Persistence is usually the key, however trying different teats, or different shaped bottles to hold, may help your situation.

If you are still having difficulty, discuss this with your healthcare professional who can offer you personalised advice.

Gagging or overeating

Gagging or gulping formula during feeding can be concerning for parents, as it may indicate that the baby is struggling to manage the flow of milk or is consuming too much too quickly. This can lead to discomfort and potential feeding issues. Some possible causes for gagging or gulping formula can include:

• Fast-flowing nipple: The hole size in a bottle’s nipple may be too big and allow too much formula to flow through for your baby. Consider using a slower-flow nipple to better match your baby’s feeding pace.
• Hunger levels: Your baby may be too hungry at feeding times, causing them to gulp in the feed as soon as they have access. Try to establish a more consistent feeding schedule, be aware of your baby’s hunger cues, and ensure your baby is fed on demand to prevent being over hungry at the next feed.
• Positioning: A baby’s feeding position may lead to difficulty swallowing.  Hold your baby in a more upright position during feeding and ensure the bottle is tilted to keep the nipple filled with formula.
• Overeating: A baby may overeat if they are allowed to feed continuously without breaks. Encourage breaks during feeding to allow the baby to pace themselves and help them burp. Recognising their fullness cues is also important.

Adjusting to bottle feeding can take time, and it's normal for infants to experience some challenges along the way. However, if you notice regular gagging, gulping, or signs of overeating during formula feeding, seek additional support from a healthcare professional. They can provide tailored advice and reassurance to help ensure your baby is feeding comfortably and effectively.

Spitting up formula

Regurgitation (also known as spitting-up or mild reflux) is when stomach contents flow back up into the oesophagus. This may or may not include vomiting and is harmless in many cases so there is often no particular need to worry, but if you are concerned, please consult your doctor. Mild regurgitation is a very common feeding issue, occurring in over 50% of infants in their first year of life. For formula fed babies, there are infant formulas that are suitable for infants with regurgitation. You should always check with your doctor before changing your current infant formula to ensure you choose the most appropriate one for your baby.

Spitting up and vomiting are often confused, but they are quite different. Spitting up typically involves small amounts of milk coming back up during or after feeding, it is often a normal occurrence for many infants and is harmless. It does not necessarily indicate that a baby has an upset stomach or is in distress. However, if spitting up is accompanied by signs such as arching the back, crying after spitting up, lack of appetite or if the spit-up is yellow or red in colour, you should seek medical attention. Possible feeding-related causes for regular spitting up may include:

• Positioning: Ensure your baby is in a slightly upright position while feeding and for a short time afterward to help with digestion.
• Nipple Flow: If the bottle nipple is causing formula to flow too quickly or too slowly, experiment with different nipple sizes to find one that allows for a comfortable feeding pace for your baby.
• Overfeeding: A baby may be consuming too much formula at once. Monitor feeding amounts and consider smaller, more frequent feedings to prevent overfeeding.
• Swallowing air: If you think your baby may be swallowing air while feeding, burp them frequently during and after feeds to help release any trapped air.

It’s important to remember that adjusting to bottle feeding can take time, and some spitting up is often normal. However, if you notice consistent spitting up accompanied by concerning symptoms, seeking additional support from a healthcare professional can provide peace of mind and guidance.

Common formula feeding problems after feeding

Some babies may experience various challenges once starting formula feeding or changing between formulas that can be concerning for parents. These issues can arise even if the feeding itself went smoothly, as they often relate to how the baby’s digestive system is adapting to formula. Understanding these potential problems and being aware of the signs of intolerance is important. If you are concerned about any of these symptoms, you should talk to your healthcare professional.

Constipation

Constipation in infants is frequently defined as difficulty in passing hard, dry (like small pellets) poo. If your baby has infrequent bowel movements, it doesn’t necessarily mean they are constipated. There can be big differences between babies when it comes to the duration between bowel movements, some being daily, some being weekly. You also can’t rely on your baby’s facial expression while doing a poo to conclude constipation either, this can be a very normal response.

With formula-fed babies, generally their poos are thicker and pastier and sometimes less frequent than breast-fed poo but this also doesn’t mean your baby has constipation. Your baby’s bowel motions can be affected by several factors, including:

• Fluid intake
• Introduction of solid foods
• Age (as age increases the stool characteristics change)
• Illness and infections
• Medications

If you have any concerns about your baby’s bowel motions, it never hurts to seek the advice of your doctor or health care nurse.

Diarrhoea

Diarrhoea is characterised by very frequent, runny, liquid stools. Diarrhoea in children is fairly common, especially during and following gastroenteritis, or “gastro”. Diarrhoea results in a significant loss of water and mineral salts from the body and therefore presents a serious risk of dehydration. Monitor your baby and their fluid intake as they can become dehydrated very quickly. If your baby is less than 6 months old, seek immediate medical attention if they show any signs of dehydration or if they experience 3 or more watery poos over the day. In older children it’s also important to see a doctor if symptoms persist or if you are concerned about your child..

There are rehydration solutions and particular probiotics available for babies that may be appropriate. A healthcare professional will be able to advise which one is best for your child.

Poo colour

If your baby is happy and thriving on the formula they are on, the colour of their poo should not necessarily be a cause for concern. You should however consult healthcare professional advice if your baby’s poo is ever red, black or white in colour.

• The colour of baby’s stools on intact-protein formulas are usually light yellow/green to brown.
• The colour of baby’s stools on a formula that has the protein broken up (hydrolysed protein formulas) can range from yellowish mustard to dark green.
• If you are using a combination of breastfeeding and baby formula, your baby’s poo will vary  depending on the ratio of breast milk to baby formula. Generally, a breastfed baby will have more yellowish to slightly green colour poo.

Changes in your baby’s stool colour may be due to several reasons

• If you are moving your baby from breastfeeding to baby formula or between formulas, it is normal for there to be changes in bowel motions, and the colour of your baby’s poo.
• If your baby has started solid food, their poo colour can also be affected by the colour of recent food choices, so keep this in mind.

If your baby has pale yellow, white or grey coloured poo you should see a doctor immediately.  At the end of the day, if you are worried about the colour of your baby’s poo, then it doesn’t hurt to see your healthcare professional to get some reassurance. 

Poo Smell

This should come as no surprise, but everyone’s poo smells… including your baby’s. Formula fed babies tend to have more pungent smelling poos compared to breastfed babies. Unfortunately, there is not much you can do about that.

It’s also useful to note that if you are moving your baby from breastfeeding to baby formula or between formulas, or starting solids, it is normal for there to be changes in bowel motions, and this can include colour and smell.

Colic

Colic is an unexplainable unsettled period where your baby is crying for a long time, sometimes for hours, and is inconsolable. The true definition is crying for more than 3 hours a day, at least 3 times a week for more than 1 week, yet otherwise growing normally. Approximately 20% of babies, both breast and formula fed, between the ages of two weeks and six months suffer from colic. There can be several causes of crying but when there is no obvious cause, and no growth concerns, fever or illness, the inconsolable periods of crying are labelled colic.

Ruling out some common discomforts (listed below) may help identify whether or not you might be dealing with baby colic. For example, are you:  

• Responding to hunger and fullness cues;
• Responding to tired signs and regular sleep patterns to ensure they are getting enough sleep;
• Changing dirty nappies to keep them comfortable;
• Burping your baby after feeding to ease built up pressure in the tummy;
• If formula feeding, preparing the bottle using the correct scoop and quantities of powder and water.

If you have ruled out the above possible causes, it’s likely time to visit your health care professional for more advice. There is some good evidence that specific probiotic strains might help reduce crying in colicky babies. Discuss with your doctor about possible treatment options.

Lactose intolerance

Lactose intolerance is a clinical condition which is due to the intestine’s inability to digest lactose, the main carbohydrate, or sugar, found naturally in milk and milk products. This inability to digest lactose is because there is not enough lactase enzyme in the intestine, which is needed to digest and breakdown lactose. There are generally two forms of lactose intolerance:

1. Primary Lactose Intolerance: An extremely rare genetic condition which requires medical intervention. This is when the body doesn’t produce enough of the lactase enzyme.
2. Secondary Lactose Intolerance: This is much more common. It occurs when the small intestine cell lining is damaged, occurring commonly after gastroenteritis. The cell lining is where the lactase enzyme lives, damage to these cells can mean an interruption and reduction of lactase activity.

If your formula fed baby suffers from lactose intolerance, an infant formula suitable for lactose intolerance would be the alternative to a standard infant formula. Speak to your health care professional before changing any infant formula.

Rashes, hives or eczema

Rashes, hives, or eczema can appear on different parts of a baby's body, such as the face, neck, or nappy area, and may arise for various reasons, including allergies to formula ingredients. These skin conditions can be uncomfortable for infants and may cause concern for parents. You should talk to your doctor about any of these symptoms. A qualified healthcare professional can help you identify potential allergens and provide appropriate dietary advice and treatment options for your child. Keeping a diary of feeding times and any skin reactions can help track patterns and inform your doctor about potential allergies.

Farting and gas

Farting and producing gas is a normal digestive process. It is a common occurrence in infants and is typically not a serious health concern. Trapped air that isn’t expelled as gas can cause discomfort after feeding and parents may want to explore potential causes to ensure their little one is comfortable. Understanding the reasons behind gas can help alleviate any discomfort.

Potential feeding-related causes for gas:

• Too much air in the bottle: If the bottle is not properly filled, it can introduce excess air into the formula. Ensure the bottle is tilted at an angle that keeps the nipple full of formula while feeding to minimise air intake.
• Inadequate burping: Burping your baby during and after feeding can help alleviate any trapped air.
• Swallowing air: Babies may swallow air while feeding, especially if they are feeding too quickly. Encourage a slower feeding pace and consider using a slow-flow nipple to help your baby manage their intake.
• Constipation or diarrhoea: A baby may experience a build up of gas if they have constipation or diarrhoea.

By addressing these potential causes, parents can help reduce their baby's discomfort from gas. If gas continues to be a concern or if the baby shows signs of distress, consulting with a healthcare professional can provide additional support and guidance.

Hunger or a lack of weight gain

Determining the right amount of formula for your baby can be challenging, as it can often be hard to tell how much is too much or too little during a feed. Every tin of infant formula has a feeding table that can be used as a guide to how much infant formula to make up. Every baby is different so these tables should only be used as a guide and it’s important to always keep an eye out for your little one’s signs of hunger and fullness. Common signs that a baby may still be hungry include rooting, sucking on their hands, or crying after feeding. If your baby is not gaining weight as expected, it may be a cause for concern and you should always discuss this with your healthcare professional. Potential causes for inadequate weight gain, and reasons to talk to your healthcare professional may include:

• Sleepiness: Encourage wakeful feeding by gently stimulating your baby before feeding times.
• Weak sucking reflex: Some babies may have difficulty latching or sucking strongly enough to get adequate nutrition.
• Improper formula preparation: If the formula is not prepared according to instructions on the tin, it may not provide the necessary nutrition and can make your baby sick. Always follow the preparation guidelines on the formula tin you are using to ensure proper mixing and measurements.
• Infrequent feedings: If your baby is not fed often enough, they may not receive adequate nutrition throughout the day. Learn your baby’s hunger cues, establish a consistent feeding schedule and feed on demand to ensure your baby is getting enough formula.