The 13 Best Baby Formulas of 2019

Overwhelmed by all the formula choices available to your baby? You’re not alone. A walk down the formula aisle at the store can send even the most seasoned parents into a panic.

Thing is — there’s no one brand or type of formula that’s universally best for all babies. And all infant formulas you’ll find sold in the United States have to go through the same nutritional and safety testing through the Food and Drug Administration (FDA).

That doesn’t mean all formulas are the same, though.

You can find formula in three forms. Powdered and liquid concentrate must be mixed with water before feeding to your baby. Ready-to-eat bottles contain liquid formula that’s already diluted with the appropriate amount of water.

Beyond that, the choices revolve around the content. Most formulas are made from cow’s milk, but you can also find soy and protein hydrolysate formulas for babies who have certain intolerances or allergies.

Best for colic

Dreaded colic. If you’re starting to link your baby’s cries to what they’re eating, consider choosing formulas specifically made to address what’s causing those wails.

But, reality check: There’s no evidence to suggest that a certain formula will make your baby better.

Instead, colic tends to ease up between your baby’s 4- and 6-month birthday. And colic formulas may not help if your little one has an allergy, so it’s a good idea to check in with your pediatrician to make sure there’s nothing more at play with their health.

Best for reflux

Is spit-up becoming more than just a laundry issue in your house? Formula-fed babies actually have higher rates of reflux than breastfed babies. These issues tend to peak around the 4-month mark.

There are formulas on the market that are thickened by rice. They may help decrease the frequency of spit-ups and don’t have any long-term safety concerns.

Best for gas

Those toots may be cute at first. But your baby may have a lot of discomfort with gas. Keep in mind that severe gas may be a sign of allergy or other medical issue. So, if switching formulas doesn’t help, head in for a check-up.

Best for constipation

There aren’t many formulas specifically marketed to help with constipation. It’s normal for formula-fed babies to have stools between two and threetimes a day before starting solids and two times a day after starting solids.

Or, your baby might have a different normal. But if they seem to be straining and passing hard stools or suddenly start going longer and longer without a dirty diaper, they may be constipated. You can try a different formula, and speak to your doctor about other ways to get things moving.

Best for supplementation

Maybe baby will receive formula only part time in combination with breastfeeding. In this case, you may want to find a formula specifically designed for supplementation.

Best for preemies

Babies born prematurely may need additional support nutritionally. As a result, formulas for preemies focus on higher calories — usually 22 to 24 per ounce versus the standard 20 — to help boost weight gain. They may also help promote long-term growth and development.

Best for allergies

Some babies may be allergic to cow’s milk protein and need hypoallergenic formula — specifically, one where the protein has been broken down either partially or extensively. These formulas are also called protein hydrolysate formulas. They’re for babies who can’t drink milk- or soy-based varieties.

Best organic

Formulas labeled organic must meet certain standards, like being made without contaminants like prohibited synthetic pesticides and fertilizers. Organic formulas are also free from artificial flavors and colors, growth hormones, preservatives, and other additives.

Best plant based

Fun fact: Around 25 percent of all formula sold in the United States is soy based. These formulas are free of both lactose and cow’s milk protein and may be better digested by some babies with certain medical conditions.

Talk with your doctor before switching to soy, however. Some studies show that preterm babies fed soy gain significantly less weight than those on standard formulas.

Best budget

Your baby drinks a ton of formula in the first year. So, you may just be thinking of the bottom line. Good news for you — beyond the well-known formula manufacturers, there are some solid generic options that provide the same nutrition and safety on a dime.

How to choose a formula

At the most basic level, there’s really no wrong choice when it comes to formula. Since everything you’ll find is technically safe to use, that means that what you put in your cart is really up to you, your preferences, and your budget.

You might ask yourself if a certain brand or type:

• is easy to find at a local store or online
• has a price point that fits within your budget
• meets your need for convenience (powder vs. liquid or pre-portioned)
• is appropriate for your child’s special needs (allergy, prematurity, etc.)

Beyond that, you’ll need to see what works best for your baby. Know that most formulas contain 20 calories per ounce. Unless your doctor tells you otherwise, you should choose a brand that contains iron (most do) to help prevent iron deficiency anemia.

Anything else that’s added to the formula, like fatty acids and other ingredients “found in breast milk,” are completely safe, but they may or may not provide the benefits written on the box.

Tips for how to use

Once you’ve chosen your formula, you’ll want to make sure you prepare it in a safe way.

• Wash your hands with soap and water before grabbing bottles and preparing your formula. While you’re at it, make sure your bottles are clean and in working order.
• Check the date on your formula container to make sure it’s not expired. Examine the container for breaks in the seal, rust marks, leaks, and other signs that the formula is compromised.
• Use water from a safe source. You might consider boiling water for a minute and cooling before mixing bottles as well. And if you don’t think your tap water is safe to use, you may want to purchase bottled water.
• Measure out the water first before adding powder or liquid concentrate. Follow the directions on the box for how much water you’ll use.
• If you choose to warm your baby’s bottle, do so by putting the bottle in a pot of warm water on the stove. Heat to body temperature.
• Use prepared formula within 2 hours or store it in the refrigerator for 24 hours. And discard any formula your baby doesn’t finish after a feeding.
• Feed your baby in an upright position and burp often to help relieve symptoms of colic. You may also want to look into curved bottles or those that use collapsible bags to reduce air intake.
• If your baby is under 3 months oldTrusted Source, was born prematurely, or has other health issues, your doctor may have additional guidelines for preparing formula.

Looking to switch formulas?

Contrary to popular belief, you don’t need to follow any specific instructions or wait any length of time before switching formulas. You can offer one at one feed and another at the next. You can even mix two types, provided you dilute them appropriately with water.

But while it’s safe to switch between brands and types, you may not want to switch frequently. The Seattle Mom Doc explains that you shouldn’t “react to every single poop.” While switching between formulas for cost or convenience may be fine, don’t do it repeatedly in search of a fix for things like colic or gas.

In other words, try giving your baby one type of formula for 1 to 2 weeks before switching.

The takeaway

There are many formula options available. All meet the nutritional needs of your baby. The key is preparing them in a safe way.

Still don’t know which formula to choose? Ask your pediatrician. Your child’s doctor may be able to point you in the right direction based on your baby’s health history or your personal preferences. Same goes with switching formula brands or types.

As an added bonus, your pediatrician’s office may even have coupons or free samples so you can try before you buy.

Antibiotics

Introduction

Antibiotics are used to treat or prevent some types of bacterial infection. They work by killing bacteria or preventing them from reproducing and spreading.

Antibiotics aren't effective against viral infections, such as the common cold, flu, most coughs and sore throats.

Many mild bacterial infections can also be cleared by your immune system without using antibiotics, so they aren't routinely prescribed.

It's important that antibiotics are prescribed and taken correctly to help prevent the progression of antibiotic resistance. This is when a strain of bacteria no longer responds to treatment with one or more types of antibiotics.

When antibiotics are used

Antibiotics may be used to treat bacterial infections that: 

• are unlikely to clear up without antibiotics 
• could infect others unless treated 
• could take too long to clear without treatment 
• carry a risk of more serious complications 

People at a high risk of infection may also be given antibiotics as a precaution, known as antibiotic prophylaxis.

How do I take antibiotics?

Take antibiotics as directed on the packet or the patient information leaflet that comes with the medication, or as instructed by your GP or pharmacist.

Doses of antibiotics can be provided in several ways: 

• oral antibiotics – tablets, capsules or a liquid that you drink, which can be used to treat most types of mild to moderate infections in the body 
• topical antibiotics – creams, lotions, sprays or drops, which are often used to treat skin infections 
• injections of antibiotics – these can be given as an injection or infusion through a drip directly into the blood or muscle, and are usually reserved for more serious infections 

It's essential to finish taking a prescribed course of antibiotics, even if you feel better, unless a healthcare professional tells you otherwise. If you stop taking an antibiotic part way through a course, the bacteria can become resistant to the antibiotic.

Missing a dose of antibiotics

If you forget to take a dose of your antibiotics, take that dose as soon as you remember and then continue to take your course of antibiotics as normal.

But if it's almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Don't take a double dose to make up for a missed one.

There's an increased risk of side effects if you take 2 doses closer together than recommended.

Accidentally taking an extra dose

Accidentally taking one extra dose of your antibiotic is unlikely to cause you any serious harm.

But it will increase your chances of experiencing side effects, such as pain in your stomach, diarrhoea, and feeling or being sick.

If you accidentally take more than one extra dose of your antibiotic, are worried or experiencing severe side effects, speak to your GP or call NHS 24 111 service as soon as possible.

Side effects of antibiotics

As with any medication, antibiotics can cause side effects. Most antibiotics don't cause problems if they're used properly and serious side effects are rare.

The most common side effects include: 

• being sick 
• feeling sick 
• bloating and indigestion 
• diarrhoea

Some people may have an allergic reaction to antibiotics, especially penicillin and a type called cephalosporins. In very rare cases, this can lead to a serious allergic reaction (anaphylaxis), which is a medical emergency.

Considerations and interactions

Some antibiotics aren't suitable for people with certain medical conditions, or women who are pregnant or breastfeeding. You should only ever take antibiotics prescribed for you – never "borrow" them from a friend or family member.

Some antibiotics can also react unpredictably with other medications, such as the oral contraceptive pill and alcohol. It's important to read the information leaflet that comes with your medication carefully and discuss any concerns with your pharmacist or GP.

Types of antibiotics

There are hundreds of different types of antibiotics, but most of them can be broadly classified into six groups. These are outlined below. 

• penicillins (such as penicillin and amoxicillin) – widely used to treat a variety of infections, including skin infections, chest infections and urinary tract infections
• cephalosporins (such as cephalexin) – used to treat a wide range of infections, but some are also effective for treating more serious infections, such as septicaemia and meningitis
• aminoglycosides (such as gentamicin and tobramycin) – tend to only be used in hospital to treat very serious illnesses such as septicaemia, as they can cause serious side effects, including hearing loss and kidney damage; they're usually given by injection, but may be given as drops for some ear or eye infections 
• tetracyclines (such as tetracycline and doxycycline)– can be used to treat a wide range of infections, but are commonly used to treat moderate to severe acne and rosacea
• macrolides (such as erythromycin and clarithromycin) – can be particularly useful for treating lung and chest infections, or an alternative for people with a penicillin allergy, or to treat penicillin-resistant strains of bacteria 
• fluoroquinolones (such as ciprofloxacin and levofloxacin) – broad-spectrum antibiotics that can be used to treat a wide range of infections 

Antibiotic resistance

Both the NHS and health organisations across the world are trying to reduce the use of antibiotics, especially for conditions that aren't serious.

The overuse of antibiotics in recent years means they're becoming less effective and has led to the emergence of "superbugs". These are strains of bacteria that have developed resistance to many different types of antibiotics, including: 

• methicillin-resistant Staphylococcus aureus (MRSA) 
• Clostridium difficile (C. diff)
• the bacteria that cause multi-drug-resistant tuberculosis (MDR-TB) 
• carbapenemase-producing Enterobacteriaceae (CPE) 

These types of infections can be serious and challenging to treat, and are becoming an increasing cause of disability and death across the world.

The biggest worry is that new strains of bacteria may emerge that can't be effectively treated by any existing antibiotics.

Back problems

Most back problems start for no obvious reason, which can be very frustrating. The spine is strong and back problems are rarely due to any serious disease or damage.

Back problems can cause a range of symptoms, including:

• stiffness
• muscle spasms
• hot, burning, shooting or stabbing pains in your back and sometimes into one or both of your legs

You may also get pins and needles - this can be due to nerve irritation.

You don't normally need to see a healthcare professional. New or flare-up of longstanding back problems should begin to settle within 6 weeks.

For most back pain problems, you'll not normally need an X-ray or MRI scan.

What causes back problems?

Although most back problems start for no obvious reason, back pain can be caused by:

• staying in one position too long
• lifting something awkwardly
• a flare-up of an existing problem

Can this cause problems anywhere else?

Your back problem may cause hot, burning, shooting, or stabbing pains into one or both of your legs. You may also get pins and needles - this can be due to nerve irritation.

Self-help

Keeping active is an essential part of your treatment and recovery and is the single best thing you can do for your health. Exercising can really help your back and reduce the pain you feel.

Try not to:

• brace or hold yourself still - your back is designed to be mobile
• sit down or rest for too long - resting in bed doesn't help back pain, and often makes it harder to get going again.

If you have to sit or rest, try to change positions regularly and find one that reduces any pain in your back or legs.

Being physically active throughout your recovery can:

• prevent a recurrence of the problem
• maintain your current levels of fitness – even if you have to modify what you normally do, any activity is better than none
• keep your other muscles and joints strong and flexible
• help you aim for a healthy body weight

It's recommended you stay at or return to work as quickly as possible during your recovery. You don't need to be pain and symptom-free to return to work.

Advice to help with your pain

The following can help to reduce the pain:

• Pain medication - this can help you move more comfortably, which can help your recovery.
• Heat or ice packs.
• Tens machine - this is a small battery operated machine that stimulates the skin to help reduce the level of pain you feel. They can be bought from chemists or online.

Speak to your community pharmacist or other healthcare professional about taking medication. It's important to take medication regularly.

Stay positive

It’s easy to start worrying about all the possible things that could be wrong, but research has shown that most back pain settles with time. Keeping as active as possible helps you to cope better and recover more quickly.

Consider your posture

Although your posture doesn’t need to be perfect, resting in poor positions can affect your back problem. Try and move often so you don't get stuck in a poor position for long.

When to speak to a health professional

If you experience any of the following, phone the 111 service as soon as possible:

• Difficulty passing or controlling urine
• Numbness or altered feeling around your back passage or genitals - such as wiping after toilet
• Pins and needles around your back passage or genitals - such as wiping after toilet

If you experience any of the following, speak to your GP as soon as possible:

• Generally feeling unwell
• Back pain that starts when you're ill with other problems - such as rheumatoid arthritis or cancer
• Unsteadiness when you walk

Help and support

If, after following the above advice, your back problem hasn't improved within 6 weeks a referral to a physiotherapist may be of benefit.

If available in your health board area, the Musculoskeletal (MSK) Helpline can refer you to a healthcare professional if you need it.

What are the effects of lowering blood pressure targets?

In 2017, the American Heart Association (AHA) lowered the threshold for what constitutes hypertension. However, what is the impact of this, and is implementing these new guidelines cost effective? Two new studies set out to investigate.

According to the AHA, around 103 million adults in the United States have high blood pressure. They expect that this number will continue to rise.

Meanwhile, the Centers for Disease Control and Prevention (CDC) estimate that around 1,100Trusted Source people die of a condition related to hypertension each day, including heart disease and stroke. These are some of the leading causes of death in the U.S.

The healthcare costs of hypertension are not negligible, either. The CDC suggest that hypertension results in almost $50 billion per year in costs, including the price of medications and missed days of work.

What are some of the measures that people with high blood pressure and healthcare professionals can take to prevent these adverse outcomes and increase lifespan? In 2017, the AHA recommended lowering blood pressure thresholds and treating people at risk more intensively.

Now, two new studies — both of which featured at the AHA's Scientific Sessions 2019, which takes place in Philadelphia, PA — have investigated the costs and benefits of treating hypertension more intensively, and of tailoring treatment according to degrees of cardiovascular risk.

Better blood pressure control lengthens life

Dr. Muthiah Vaduganathan, an instructor of medicine at Harvard Medical School and an associate physician at Brigham and Women's Hospital — both in Boston, MA — is the lead author of the first study.

Dr. Vaduganathan and team used data from the well-known Systolic Blood Pressure Intervention Trial (SPRINT).

The SPRINT examined the effects of lowering systolic blood pressure readings to a target of 120 milligrams of mercury (mm Hg) instead of the usual 140 mm Hg.

The trial followed 9,361 participants, all of whom were over the age of 50 and at high cardiovascular risk. The SPRINT followed them for 6 years and concluded that lowering blood pressure targets reduced the risk of cardiovascular problems — such as heart attack, stroke, heart failure, and cardiovascular death — by 25%.

The participants were at high risk of heart disease if they had had a cardiovascular disease that was not stroke, scored highly on the 10 year cardiovascular risk score, had chronic kidney disease, or were older than 75.

For the new study, the researchers analyzed the data to project the lifespans of the participants who underwent intensive hypertension treatment to lower blood pressure to a target of 120 mm Hg. They compared these projected lifespans with those of participants who received the standard treatment that aimed for a blood pressure of lower than 140 mm Hg.

The study revealed that intensive blood pressure treatment increased lifespan by 4–9%, compared with standard care.

"In contrast with the oldest patients, middle-aged patients had the greater absolute benefit because they start with a longer expected lifespan and can receive the intensive treatment over a longer period of time," explains Dr. Vaduganathan.

Dr. Mitchell S. V. Elkind — the AHA president-elect and chair of the Advisory Committee of the American Stroke Association — comments on the results. He says, "This analysis of the [SPRINT] suggests that [there are] additional years of life that can be added by more aggressive control of blood pressure."

He adds, "When you tHigh blood pressure has been implicated as one of the reasons for stalled progress in reducing heart disease-related deaths in the United States," Dr. Vaduganathan says. "These data reinforce that tighter blood pressure control, especially when started earlier in life, may meaningfully prolong lifespan."

New guidelines to treat an extra 5.2 million

The second study examined the best way to implement the new blood pressure guidelines issued by the American College of Cardiology (ACC) and the AHA.

These new guidelines lowered blood pressure thresholds to define hypertension as anything from 130/80 mm Hg to 140/90 mm Hg.

The new guidelines also recommend medication treatment for people with a blood pressure reading of 130/80 mm Hg to 139/89 mm Hg if they have a history of heart attack or stroke, or if they have a high 10 year risk of experiencing such an event.

Joanne M. Penko — a research data analyst at the University of California, San Francisco — is the lead author of this second study.

To assess the cost effectiveness of implementing the new guidelines, Penko and colleagues looked at healthcare costs and quality-adjusted life years (QUALY). They used the Cardiovascular Disease Policy Model, a well-known computer simulation model, to estimate healthcare costs over a 10 year period.

Compared with the 2003 guidelines, the analysis revealed, the "2017 ACC/AHA guidelines would treat 5.2 million more adults 35–84 years of age, intensify treatment in another 11.7 million, and prevent about 257,000 [cardiovascular] events over 10 years."

Intensifying treatment pays off over a 10 year period for men aged 65–84 and women aged 75–84 who already have cardiovascular disease. For others, however, the costs outweigh the benefits.

Furthermore, treating people at high cardiovascular risk who had not had cardiovascular disease would only be intermediately cost effective for adults whose blood pressure readings are 140/90 mm Hg or higher at baseline. It would not be cost effective at all for those whose blood pressure readings are 130/80 mm Hg to 139/89 mmHg.

"Previous studies have shown that compared with no treatment, treating high blood pressure according to the 2003 Seventh Report is cost effective over 10 years," Penko says. "We were surprised to learn in our study that wasn't the case for all patients indicated for medication treatment in the 2017 guidelines."ell people that lowering their blood pressure is going to reduce their chance of having a stroke or a heart attack by 25%, which is what [the SPRINT] showed," the question that naturally ensues is "what does that number mean, in real terms?"

Could the eyes predict cardiovascular risk?

Doctors consider a variety of factors to determine a person's risk of experiencing cardiovascular events, including age, smoking history, and blood pressure. But changes to the blood vessels in the back of the eye may make for a more accurate prediction.

They say that the eyes are the window to the soul. But, according to a team of researchers, they may also be the window to the heart.

Previous research has identified a link between changes in the eye and hypertension in adults, and similar retinal changes and high blood pressure in children.

"The data that we have is very clear that at a very early age, in children 6 to 8 years old who are otherwise healthy, you can already see vascular alterations due to blood pressure levels that are on the high end of normal," says Dr. Henner Hanssen, professor of preventive sports medicine and systems physiology at the University of Basel, Switzerland.

"We don't know if this predicts worse outcomes when they become adults, but we have seen similar alterations in adults that are predictive of cardiovascular mortality and morbidity," he continues.

Millions of blood vessel measurements

This study is the largest to look at the relationship between the eye and cardiovascular diseases and has produced the most dependable measurements. It appears in the American Heart Association's Hypertension journal.

The study found that small blood vessels at the rear of the eye were affected by artery stiffness and increased blood pressure.

As lead author professor Alicia Rudnicka from London's St. George's University in the United Kingdom explains: "If what's happening in the rest of the body is reflected in what's happening at the back of the eye, what we see there could be a flag, taking retinal morphology assessment from being just a research tool to incorporating it into clinical practice."

Almost 55,000 elderly or middle-aged people from the UK Biobank study formed the data set for the new research, and in total, the team had access to 3.5 million blood vessel sections.

An automated program examined digital images of each participants' retinal blood vessels, providing the team with measurements relating to blood vessel diameter and curvature.

The retinal link to heart disease

Analysis of these found that greater curvature of the retinal arteries equated to higher pulse pressure, higher average artery pressure during a heartbeat, and higher systolic blood pressure, which is the pressure that occurs when the heart contracts.

This was not the only finding. The team also noticed a relationship between greater stiffness in artery walls, higher mean arterial pressure, and narrowing of the retinal blood vessels.

None of these retinal effects impact a person's vision, but they "could potentially tell us very quickly whether you are on the road to cardiovascular disease," according to Prof. Rudnicka.

"What we have now is one piece of the puzzle," she adds.

The team's next study aims to determine whether these measurements can predict heart disease in the same person a decade later.

Cardiovascular disease is the leading cause of deathTrusted Source globally. Currently, experts estimateTrusted Source a person's risk factor using a range of factors, including age, sex, blood cholesterol levels, and blood pressure.

Prof. Rudnicka's future study results may determine whether the eye becomes part of that list.