Understanding Imported European Infant Formulas
As pediatricians and parents…
…we understand why parents want to do whatever they can to provide their child with the healthiest start, and this is especially true when it comes to what to feed your infant. Over the past few years, we have noticed certain feeding trends, including the use of imported European baby formulas.
Here are the answers to the common questions we are asked on European infant formulas:
Q: Why do people say that European infant formula is superior to U.S. formula?
Parents who use imported European formulas state that they believe the European formulas contain fewer synthetic ingredients, have an organic option, contain lactose, and have less pesticides. Though there are more grass-fed and organic options in Europe, infant formula in the US is tightly regulated by the US FDA, and it is the only food that is protected under its own act, the Infant Formula Act.
Q: What are the risks of ordering infant formula like HiPP and Holle from Europe?
European formulas meet the standards set in the European Union and are safe to consume when purchased in Europe. However, when obtained in the US, it’s often via third-party vendors. Purchasing formula this way means they’re imported outside of their normal “chain of control” and bypass the safety regulations set by the European Union and US FDA. This creates the following concerns:
Potential tampering and contamination
Formulas may be stored at incorrect temperatures, which could prematurely start to deteriorate the formula and it will start to lose key nutrients.
Labels are not in English which can lead to confusion on how to correctly prepare and in interpreting use by dates.
If European formula is recalled for health or safety reasons, US parents may not be notified in a timely matter.
Q: What specific nutrients should I be looking for in an infant formula? DHA, prebiotics, probiotics, vitamin D, iron, etc.?
Currently in the US, there are standard nutrients, including vitamin D and iron, that are recommended at certain levels to ensure adequate growth and nutrition for all infants. Newer ingredients have been added, including DHA, probiotics, prebiotics and other fats and carbohydrates, since these ingredients are naturally found in breast milk. The jury is still out on the long-term benefits for most of these special ingredients. When choosing a formula, remember that all US Infant formulas regulated by the FDA will be appropriate. Of all the additional ingredients, DHA, specifically at higher levels, may be the most beneficial. Though it has been added to formula for the past 2 decades, recent research on DHA demonstrates that it may have positive long-term effects on cognitive development in children.
Q: I've heard that infant formula in the U.S. is filled with corn syrup and European ones do not - are there U.S. brands available that are like European in terms of type of carbohydrate used?
In general, formulas try to mimic breast milk in every way. Most US (and European) formulas contain lactose as its main carbohydrate source. Other carbohydrate sources including corn syrup solids, brown sugar syrup, maltodextrin and rice starch, are added to more specialized formulas, including partial and extensively hydrolyzed protein, and added rice formulas.
Q: How important is it to give my baby organic formula as opposed to non-organic?
There is no data that organic formula has any short- or long-term benefits to children, however, if you choose to use organic formula, it is safe to give your infant. The current thought is that formula is comprised of individual ingredients and how the cow is fed is less important.
Q: Are there brands in the U.S. that are similar to European formulas, and are they generally superior?
There is a new European style formula that is US FDA registered that contain ingredients similar European formulas including lower iron and high DHA levels. This formula may be useful for the parent who would prefer using a formula that is like the European ones without having to worry about the risks associated with how it is imported, but there is no data that it offers any short-term or long-term benefit to infants.
Deepest thanks to American Academy of Pediatrics spokespeople, Dr. Anthony Porto, MD and Dr. Dina DiMaggio for sharing their expertise on this topic. Anthony is an Associate Professor of Pediatrics and Associate Chief of Pediatric Gastroenterology at Yale University. He is the medical director of the Yale Pediatric Celiac Program and sees patients in Greenwich, Norwalk, and New Haven, CT. He has won numerous awards including the Norman J. Siegel Award at Yale University in 2015 for leadership and providing outstanding clinical care as well as Physician of the Year during his time at Morgan Stanley Children’s Hospital. He has been named Castle Connolly Top Doctors since 2012. Anthony is interested in nutrition, especially in the care of children with difficulty gaining weight, feeding issues, and celiac disease.
Dina is a board certified pediatrician and practices general pediatrics at Pediatric Associates of NYC and NYU Langone Health. She has received numerous research awards, along with Patient’s Choice Award (2008 to 2012) and compassionate doctor recognition (2010, 2012). She was listed in 2014 and 2015 as a New York Rising Star, as a Castle Connolly Top Doctor in Pediatrics from 2019-2021, and as a NY Super Doctor from 2016 to 2021. She is a medical expert for the BUMP and Baby Center and is also a freelance writer for the NYT parenting section, offering up-to-date parenting advice. Together, Anthony and Dina co-authored the Pediatrician's Guide to Feeding Babies and Toddlers (affiliate link). They regularly contribute articles to numerous national medical societies, on-line health blogs and news outlets.
For more guidance on infant and child health, follow Dr. Porto and Dr. DiMaggio on Instagram.