A Pediatrician's Perspective on Infant Nutrition and Toddler Formula

Baby Formula Expert Anthony Kovatch, MD

Anthony Kovatch, MD, completed his undergraduate education at the University of Pennsylvania. He went on to attend medical school at Hahnemann Medical College, which is now part of Drexel University. He continued his pediatric training at Pediatric Cornell North Shore University Hospital and served a fellowship in Pediatric Infectious Diseases at Children's Hospital of Pittsburgh. For the past 30 years, he has been a practicing pediatrician in Pittsburgh and is currently working at Pediatric Alliance.

Pediatrician Anthony Kovatch, M.D., recently sat down with Parent's Choice Infant Formula website editors to answer a few questions regarding the importance of toddler formulas – commonly referred to as "follow-up" or "stage two" formulas – for babies 9 to 24 months old.

Dr. Kovatch has been practicing medicine for more than 30 years and is the recipient of a "Patient's Choice" award from an independent national survey that recognizes physicians who make a difference in the lives of their patients. The honor is bestowed to physicians who have received near perfect scores as voted by patients.

Q: Dr. Kovatch, before we discuss the nutritional needs of older infants and the role toddler formula should play in infant feeding, would you please share your overall thoughts on infant nutrition?

A: For starters, I recommend breast milk for babies and so do my colleagues and fellow members of the American Academy of Pediatrics. Peer-reviewed literature and well documented research have demonstrated the many benefits of breastfeeding.

Infant nutrition is a public health issue, not a lifestyle choice. Ultimately the caregiver has two options: breast milk or infant formula. Breast milk doesn't cost anything and is the ideal way to meet a baby's nutritional needs. Infant formula is a safe and effective alternative. Infant formula is highly regulated by the Food and Drug Administration and must satisfy an infant's nutritional needs as an alternative to breast milk.

Q: Is there any particular infant formula brand you recommend to your patients?

A. I think most new parents first become familiar with big-name infant formula brands in the hospital, where some of the large national brands give away free baby formula samples to newborns. A common misperception among new parents, and frankly, among busy pediatricians, obstetricians, and family practitioners, is that more expensive brand names mean better quality and nutrition. This is far from the truth. Parent's Choice Infant Formula sold at Walmart and other store brand infant formulas sold by other retailers offer the same nutritional value and meet the same FDA and AAP standards as the pricier, heavily marketed national brands.

So, no, I don't recommend specific infant formula brands because I know that all infant formulas manufactured in the United States must be formulated with an approved set of ingredients and provide the same complete nutrition. All infant formulas must meet the same exact nutritional requirements of the Federal Food, Drug, and Cosmetic Act which is under the regulation of the FDA. The FDA inspects all U.S. formula factories regularly and makes certain the end products are safe for use as a sole food source for infants.

New parents may not have the time or expertise to learn the truth about infant formula. In general I would say they defer to their pediatrician's guidance. Unfortunately, many health-care professionals have limited time to digest detailed information on infant formulas. Since they're familiar with brand names in hospital sampling programs, they may tend to recommend specific brands because there is little time in their busy schedules to educate themselves on the similarity of a store brand formula like Parent's Choice Formula to national-brand formulas.

Q: Why should parents consider using toddler formula as opposed to using cow's milk?

A: Breast milk and commercial infant formulas provide all the nutrients most infants need during that critical first year of life. In fact, the AAP recommends all infants be fed breast milk or iron-fortified formula for at least 12 months. I stand by this recommendation and advise my patients to hold off on milk until the child is older than one year. In fact I encourage mothers who breast feed successfully to continue into the second year (or even the third year) if both parties are willing and able. I am even seeing ambitious mothers breastfeed an older sibling along with a new baby.

Undoubtedly, older infants – especially those who are older than nine months – need more calcium to support their bone growth and development as they turn to a diet that increasingly involves baby foods and cereals. Toddler formula contains more calcium, iron, nucleotides found naturally in breast milk, and prebiotics to support the immune system. Toddler formula also contains the essential fatty acids DHA and ARA, which are abundant in breast milk and may support brain and eye development.

Cow's milk should not be fed to infants who are younger than 12 months. Leading health authorities, including the AAP, NIH, and the Mayo Clinic, do not recommend cow's milk for infants under one year of age. Cow's milk does not contain the healthiest types of fat for growing babies. Milk contains high concentrations of protein and minerals, which can cause problems with a newborn's kidneys and cause severe illness in the event of fever or diarrhea. Infants who are fed cow's milk or milk substitutes from plant sources such as soy or almond milk do not digest enough nutrients like vitamin E, vitamin C, iron, and essential fatty acids. In addition, the protein and fat in whole cow's milk can become troublesome with an infant's digestion and nutrient absorption. I've seen this time and time again in my practice.

Q: So toddler formula is a great way to fill the nutrition gap for older infants who are beginning to eat baby foods and other solids but still require essential fats, iron, and other nutrients that are not adequately present in whole cow's milk?

A: Absolutely, I believe toddler formula is certainly an option, especially considering the need for healthy fats and vitamins. Toddler formula offers complete nutrition and is a healthy transitional nutrition option for older infants who still need iron and essential lipids like DHA and ARA. Formulas like Parent's Choice Toddler Infant Formula and brands like Go-and-Grow® and Enfagrow™ also contain prebiotics, which support infant immune health. Toddlers, who are poor eaters, refuse whole cow's milk or plant-based milk, or gain weight inadequately, are definite candidates for toddler formula.

Q: Lastly, would you please share any experiences you've had with recommending store brands like Parent's Choice Formula?

A: I have witnessed a changing mentality in my practice. When parents receive confirmation that a store brand like Parent's Choice provides high-quality nutrition comparable to costly name-brand formulas, the family adopts the store brand as their personal brand. The difference between the store brand and the name brand disappears with the exception of cost-savings and value.

In my experience, giving my blessing to a parent's use of a store brand formula would be part of the care and service expected by families. I believe pediatricians today need to communicate the information they have concerning infant and toddler formula. I recommend moms and dads ask their family physicians about Parent's Choice Infant Formula and other store brands.

I believe the practice of pediatrics involves a range of considerations in addition to health, including education and economics. Modern-day parents want to make informed, customized decisions regarding formula after personalized consultation with their physician. Ultimately, parents will weigh relevant factors such as price, availability, and nutritional similarities and make decisions that best suit their needs. I predict an unstoppable trend toward the use of store brand infant formulas in the coming years, along with a heightened sense of awareness regarding the dietary needs of older infants and the benefits of toddler formula.

Enfagrow™, Premium™, Next Step® and LIPIL® are registered trademarks of Mead Johnson & Co.
Similac® and Go & Grow® are registered trademarks of Abbott Laboratories.
Parent's Choice Toddler Infant Formula is neither made by nor affiliated with Mead Johnson & Co. or Abbott Laboratories.