Bottle (Formula) Feeding Advice

  1. Types of Formulas:
  • Milk-protein formulas, soy-protein formulas, and hydrolysate formulas
  • Soy formulas don't contain lactose or milk protein
  • Currently, 20% of infants in the U.S. are fed soy formula (often without valid reason)
  • Hydrolysate formulas are indicated for children who are sensitive to both milk protein and soy protein
  1. Switching Formulas and Milk Allergies:
  • Switching from one milk-based formula to another milk-based formula is not helpful for any symptom
  • Switching from milk formula to soy formula is helpful for cow's milk allergy (1-2% of infants), severe diarrhea (from acquired lactase deficiency), and vegetarianism
  • Switching formulas for excessive crying, spitting up or gas is rarely helpful
  • Don't switch formulas without discussing it with your child's doctor
  1. Powdered versus Liquid Formulas:
  • Formulas come in 3 forms: powder, concentrated liquid and ready-to-feed liquid
  • Concentrated formulas are mixed 1:1 with water
  • Ready-to-feed formulas do not need any additional water
  • Powdered formulas are mixed 2 oz. (60 ml) of water per each level scoop of powder
  • Powdered formula is the least expensive and ready-to-feed formula is the most expensive
  • Powdered formula is the most convenient to supplement breastfeeding
  • Ready-to-feed formula is the most convenient for traveling
  1. Whole Cow's Milk, 2% and Skim Milk:
  • Whole cow's milk should not be given to babies before 12 months of age. (Reason: increased risk of iron deficiency anemia and allergies)
  • Skim milk or 2% milk should not be given to children before 2 years of age. (Reason: the fat content of whole milk (3.5%) is needed for rapid brain growth)
  1. Vitamins and Iron:
  • Use a formula that is iron fortified in all infants to prevent iron deficiency anemia
  • The amount of iron in iron-fortified formulas is too small to cause any symptoms, including constipation and diarrhea
  • Iron-fortified formulas contain all vitamin and mineral requirements except for fluoride
  • Vitamin supplements are therefore not needed for infants taking formula
  • From 6 months to 16 years of age, some children need fluoride supplements (prescription item) to prevent dental caries. (EXCEPTION: present in water supply of most cities.) If prescription needed, discuss with your doctor during office hours
  1. Water to Mix With the Formula:
  • For preparing a batch of formula distilled, bottled, or boiled water is required
  • Most city water supplies are safe for making 1 bottle at a time. Run the cold tap water for 1 minute. Don't use warm tap water. (Reason: to avoid potential lead exposure). Heat cold water to desired temperature. Add this to powder or formula concentrate. EXCEPTIONS: Untested well water, city water with recent contamination, or your child has decreased immunity
  • For these situations, use distilled water, bottled water, or filtered tap water
  • Another option is to use city water or well water that has been boiled for 10 minutes (plus 1 minute per each 1,000 feet or 305 meters of elevation)
  • Bottled water is more expensive than distilled water
  1. Extra Water:
  • Babies do not routinely need extra water. (Reason: plenty in formula)
  • Excessive water can cause seizures from water intoxication
  • Can offer some water if weather is very hot
  • Don't give > 4 ounces of extra water/day during the first 6 months of life
  • After starting solid foods, infants need more water
  1. Amounts - How Much Per Feeding:
  • The average amount of formula (in ounces) that babies take per feeding usually equals the baby's weight (in pounds) divided in half (or equal to the weight in kg)
  • The average ounces of formula the baby takes in 24 hours is the baby's weight in pounds multiplied by 2 (or kg multiplied by 4)
  • A baby's appetite varies throughout the day. If the infant stops feeding or loses interest, the feeding should be stopped
  • If your baby is healthy and not hungry at several feedings, increase the feeding interval
  • The maximal amount of formula recommended per day is 32 ounces (1 liter)
  • Overfeeding can cause vomiting, diarrhea or excessive weight gain
  • If your baby needs more than 32 ounces ( 1 liter) and is not overweight, start solids
  • Discard any formula left in bottle at end of each feeding. (Reason: it's contaminated)
  1. Frequency of Feedings (Schedules): Babies mainly need to be fed when they are hungry. If they are fussy and more than 2 hours have passed since the last feeding, they usually need to be fed. The following are some guidelines:
  • From birth to 3 months of age, feed every 2 to 3 hours
  • From 3 to 9 months of age, feed every 3 to 4 hours
  • Infants usually set their own schedule by 1 to 2 months of age
  1. Length of Feedings:
  • Feedings shouldn't take more than 20 minutes
  • If the feeding is prolonged, check the nipple to be sure it isn't clogged
  • A clean nipple should drip about 1 drop per second when bottle of formula is turned upside-down
  1. Night Feedings - How to Eliminate:
  • Most newborns need to be fed at least twice each night
  • By 3 to 4 months of age, most formula-fed babies give up middle-of-the-night feedings
  • The following tips can help your baby sleep for longer intervals during the night:
  • Keep daytime feeding intervals to at least 2 hours. Gradually stretch them to 3 hours
  • If your baby naps for > 3 consecutive hours during the day, awaken him for a feeding
  • Place your baby in the crib drowsy but awake. Don't bottle feed or rock until asleep
  • Make middle-of-the-night feedings brief and boring compared to daytime feedings. Don't turn on the lights, don't talk to your child, and feed him rather quickly
  1. Formula Temperature:
  • Most infants prefer formula at body temperature
  • In the summertime, some infants prefer formula that's cooler
  • In the wintertime, some prefer warm formula
  • There's no health risk involved except to make sure the formula is not so warm that it might burn the baby's mouth
  1. Formula Storage:
  • Prepared formula should be stored in refrigerator and must be used within 48 hours
  • Open cans of formula should be kept in refrigerator, covered and used within 48 hours
  • Prepared formula left at room temperature for more than 1 hour should be discarded
  • Leftover used formula should always be discarded. (Reason: it's contaminated)
  1. Cereals and Other Solids:
  • Bottle-fed infants should be started on solids (cereal or fruit) between 4 and 6 months
  • Starting before 4 months is unnecessary and has the disadvantage of making feedings messier and longer. Early solids can also cause gagging
  • Solids don't increase sleeping through the night for bottle-fed infants
  • Delaying solids past 9 months of age runs the risk that your infant will refuse solids
  1. Burping:
  • It is not harmful if a baby doesn't burp
  • It doesn't decrease crying
  • It does decrease spitting up
  • Burping can be done twice per feeding, once midway and once at the end
  • If your baby does not burp after 1 minute of patting, it can be discontinued
  1. Baby Bottle Tooth Decay:
  • Some older infants and toddlers have learned to expect their bottle at naptime and bedtime
  • Severe tooth decay can be caused by falling asleep with a bottle of milk or juice
  • Prevent this bad habit by not using the bottle as a pacifier or security object
  • If you cannot discontinue the bottle, fill it with water instead of formula or milk
  1. Traveling:
  • Use prepackaged bottles of ready-to-feed formula (most expensive)
  • Or mix formula ahead of travel and carry in a cold insulated container
  • Or use powered formula. Put the required number of scoops in a bottle. Carry clean water in a separate bottle. Mix prior to each feeding
  1. Nipples and Bottles:
  • Any commercial nipple/bottle is fine
  • It is not necessary to sterilize bottles or nipples if they are washed with soap and water and thoroughly rinsed
  • It is okay to wash bottles and nipples in the dishwasher
  1. Formula-Fed Stools, Normal:
  • Formula-fed babies pass 1 to 8 stools per day during the first week, then 1 to 4 per day until 2 months of age. The stools are yellow in color and peanut butter in consistency
  • After 2 months of age, most infants pass 1 or 2 stools per day (or 1 every other day) and they have a soft solid consistency