All You Need to Know About Breastmilk Substitutes

All You Need to Know About Breastmilk Substitutes

When it comes to breastfeeding substitutes - the reasons and options can be many! However, in matters of breastfeeding you can almost always use some professional guidance. Well, here we are to your rescue.

Read on as we bring you excerpts from Dr Mahesh Balsekar’s book - O to  2 Baby & You and get you some first-hand expert advice on the subject.

As written in the book, in his words...   


Stay at home mothers

If you are at home and the baby is doing well, you could start weaning  with solids. Babies do very well on breast milk and solids for up to 10-12 months without the need for supplementary milk. You can start top-up milk at any stage you want. 7-8 months is a good age to start one top feed so that the baby gets used to milk coming from a cup. The last feed is a good time as it helps the baby sleep better through the night.


Working Mothers

If you are a working mother, it is better to wean with formula or fresh milk. This is because in the initial weeks, babies takes only small amounts of solids, and need a top-up with breast milk. If the mother is not around, the baby will be unsatisfied. Once the baby is taking formula/fresh milk in adequate quantities, the mother will feel confident about going to work. The mother can then gradually start the baby on solids.



The choice of breast milk substitutes would be:

  • Fresh milk
  • Cow’s milk formula
  • Soy-based formula
  • Special formula



Above 1 year: Fresh milk is a good source of nutrition in infants.

Above 1 year: The use of fresh milk for infant nutrition varies in different settings.


Developed world: In the developed world, infants are routinely fed infant formulas. Academic bodies like the American Academy OF Pediatrics recommends  that milk should not be given until 1 year of age.

The concern with use of cow’s milk in infancy is the higher likelihood of iron deficiency anemia, higher chance of milk allergy, and risk associated with inappropriate amounts of protein, sugar, sodium and phosphorus in cow’s milk.

Developing world: The use of infant formula is often discouraged due to the high cost of infant formulas, and the risk of infection due to bottles and contaminated water. In communities where one is uncertain about the hygienic preparation of formula, fresh milk can be started at any time of birth.

In families where one is certain about the hygienic preparation of formula, infants are advised formula in the first 6 months, Families may choose to continue using formula till 1 year of age. After 6 months, families are given the option of switching to fresh milk since infants do well on fresh milk. WHO supports the use of fresh milk in older infants.


Formula or fresh milk?

Under 6 months Formula

6-12 Months Formula or fresh milk

Over 12 months Fresh Milk



Which milk?

Cow’s milk

Buffalo’s milk with cream removed

UHT–Tetrapac milk



0 – 2 months 2 parts milk: 1 part water

2 – 3 months 3 parts milk: 1 part water

> 3 months Undiluted milk


Added sugar?

  • Sugar may be added – 1/2 teaspoon in 6 oz/180 ml milk.
  • Start tapering the sugar after 3 months.
  • Stop adding sugar by 6 months of age, before teething begins.


Preparation of Formula

  • Wash hands.
  • Use sterile water.


Which water?

  • Tap water boiled for at least 10 minutes.
  • Boiling ultraviolet filtered water is another good option.
  • It is not necessary to use ‘bottled’ water for preparation of formula.


How to store the sterile water?

  • Store in a sterile steel vessel with a lid.
  • Avoid using a thermos flask because flasks cannot be sterilized.


How to prepare the formula?

  • Most formulas are offered in a proportion of 1 (level) measure in 1 oz (30 ml) of water.
  • The recommendation can differ for each product so it is advisable to

check the directions on the different products.


What Temperature?

  • Breast milk is at ‘body temperature’ and not ‘hot’.
  • It’s okay to use room temperature water.
  • If the milk has been stored in the refrigerator, you may remove the chill by placing prepared formula in a bowl of warm water or use a bottle warmer.
  • Never use ‘microwave’ to heat milk. Microwaves heat milk unevenly.
  • If milk has been heated, always check the temperature on the back of your hands.


How to Use the Formula?

  • Formula is to be used within an hour of preparation if kept at room temperature.
  • Formula can be stored in the refrigerator for several hours.
  • While travelling, it is recommended that mothers do not carry prepared formula. Sterile water may be carried in a bottle for convenience. It’s best to add formula powder to the water just prior to the feeding.

For a happy breastfeeding journey, consult a Lactation Expert.



It is well-known that breast milk is a superior source of nutrition for infants. However, mothers who need to use formula for their infants need not worry. Infants do well on formulas. The formulas made from cow’s milk are the standard formulas used for infants. The composition of most of the available formulas is very similar to breast milk, and follows the recommendations of the international nutrition societies. More advanced formulas now available are closer to breast milk because they have added Omega 3 and DHA, both of which are essential for brain growth. Some also have added ‘probiotics’, so that the growth of ‘Friendly’ gut bacteria is encouraged.


Type of Formulas

Standard Formulas For infants under 6 months. (Similar to breast milk)

Follow-up Formulas For infants over 6 months. (Higher protein content suitable for a growing infant)

Pre-term Formulas For low birth weight infants under 2 kg (Higher calorie and protein content)



These formulas are not nutritionally superior to cow’s milk formulas, and are used under special circumstances.

  • In soy formulas, soya protein replaces cow’s milk proteins, so these formulas are useful for infants with cow’s milk protein allergy.
  • In most soy formulas, the milk sugar ‘lactose’ is replaced with other sugars like sucrose or maltidextrins so it is also useful in ‘lactose intolerance’. Soy formulas are commonly used in cases of prolonged diarrhoea, where there is a high likelihood of lactose intolerance.



These formulas are for special needs. Most specialised formulas are not available in India.

  • Hypo Allergic (HA) formulas are commonly used for infants with suspected cow’s milk allergy. These formulas are recommended in infants with a strong family history of allergic diseases like asthma and eczema.
  • Predigested formulas are used in infants with severe diarrhoea who are unable to digest normal milk.


Also read: Breastfeeding Basics: How Much And When

Explore the entire collection of articles: Breastfeeding Tips

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