Using Concentrated Liquid
Most concentrated liquids contain 40 kcal/fl oz and when diluted 1:1, produce a formula that contains 20 kcal/fl oz. If a more concentrated final formula is desired using these products, use the upper part of the following Table. For the few concentrated liquid products that contain 38 kcal/fl oz and normally produce a formula with 19 kcal/fl oz, more concentrated formulas can be made using the lower part of the following Table.
Concentrated Liquid 1 Can | Added Water | Approximate Yield, fl oz | Approximate Final Caloric Density, kcal/fl oz |
|---|---|---|---|
Using Concentrated Liquid That Normally Produces a Formula With 20 kcal/fl oz | |||
13 fl oz | 13 fl oz | 26 fl oz | 20 |
13 fl oz | 11 fl oz | 24 fl oz | 22 |
13 fl oz | 9 fl oz | 22 fl oz | 24 |
13 fl oz | 6 fl oz | 19 fl oz | 27 |
13 fl oz | 4.5 fl oz | 17.5 fl oz | 30 |
Using Concentrated Liquid That Normally Produces a Formula With 19 kcal/fl oz | |||
13 fl oz | 13 fl oz | 26 fl oz | 19 |
13 fl oz | 10 fl oz | 23 fl oz | 21 |
13 fl oz | 8 fl oz | 21 fl oz | 24 |
13 fl oz | 5 fl oz | 18 fl oz | 27 |
13 fl oz | 4 fl oz | 17 fl oz | 29 |
From American Academy of Pediatrics. Pediatric Nutrition. 9th ed. American Academy of Pediatrics; 2025.
Using Powder
Because of the variability of scoop sizes for different formulas from different manufacturers and the variability of household measures, no single set of recipes can be provided that is safe for all products. Some manufacturers provide recipes for their specific products on their websites. In the absence of such information, contact the manufacturer directly. Here is an example of how to increase caloric density by using powder.
An Example of How to Increase Caloric Density of Human Milk or Standard Infant Formulaa
Goal (Cal/fl oz)b | Human Milk or Prepared Standard Formula (fl oz) | Amount of Standard Formula Powder to Be Added to Achieve Goal |
|---|---|---|
22 | 3 4 16 | ½ tsp ½ tsp + ¼ tsp 1 tbsp |
24 | 2 5 8 | ½ tsp + ¼ tsp 2 tsp 1 tbsp |
SI conversion factor: To convert fl oz to mL, multiply by 30.
a Manufacturer information for standard formula powders (Cal/g, grams per scoop, grams per household measuring spoon) was used to calculate measurements that could be easily followed for fortification of breast milk. These measurements are reviewed regularly and adjusted based on changes in manufacturer data. Although changes in formula powder are typically minute and do not generally result in a need to change these measurements, significant future changes to manufacturer formulations could make this information obsolete. Please refer to the Table source for the most up-to-date measurements.
b When using different formula brands, final calorie concentration may vary slightly. This is not generally clinically significant if a major US or generic formula is used. However, the information in this Table should not be used with any European formulas or formulas not approved by the US Food and Drug Administration.
From Muth N, Tanaka M. The Clinician’s Guide to Pediatric Nutrition. American Academy of Pediatrics; 2023. Adapted with permission from Children’s Minnesota Clinical Nutrition Team. Breast milk: fortified. Revised November 2020. Accessed October 11, 2024. https://www.childrensmn.org/references/pfs/nutr/breast-milk-fortified-(using-20-cal-oz-standard-formula).pdf.
Increasing Caloric or Protein Density Using Additives
Note that increasing caloric density using fat and/or carbohydrate should be performed with caution, because the additional energy (calories) effectively decreases the density (amount per 100 kcal) of all other nutrients.
Adapted from American Academy of Pediatrics. Pediatric Nutrition. 9th ed. American Academy of Pediatrics; 2025.