Here are a few guidelines if you decide to feed your baby formula from a bottle:
- If you have been breastfeeding and your baby is younger than a year, ask your doctor to help you choose the best formula for your baby.
- Do not give cow’s milk to babies under the age of twelve months. Drinking cow’s milk can increase your baby’s risk of developing anemia and allergies.
- Always prepare formula with cool or lukewarm water. Boiling the water is not necessary. Bottled or tap water is fine.
- To prepare a bottle of formula, follow the directions on the package carefully. First, measure the water into a clean bottle. Next, add the correct amount of powder or concentrated liquid and shake to mix. Let a few drops fall on your wrist to test the temperature. It should be lukewarm.
- Never microwave your baby’s bottle. This can create hot spots and cause burns.
- Always follow the package directions or the directions of your doctor. Never add extra powder or water. Never add sweetener. Don’t add food to the bottle, unless your pediatrician recommends it.
- Feeding time should be a relaxing experience. It gives your baby both food and the security of being held. Make sure you both are comfortable. Hold the baby in a semi-sitting position. Keep the bottle tilted so that formula is always in the nipple or neck of the bottle to avoid the baby sucking air. Do not prop the bottle.
- Gently remove the bottle from time to time to let your baby rest.
If you have any questions or if you are worried about your baby’s eating, call your doctor!
Types of Formulas
- There are three main types of formulas: milk-protein formulas, soy-protein formulas, and hydrolysate formulas.
- Soy formulas don’t contain lactose or milk protein
- Hydrolysate formulas are indicated for children who are sensitive to both milk protein and soy protein.
Switching Formulas and Milk Allergies
- Switching from milk formula to soy formula is helpful for cow’s milk allergy, which affects 1-2% of infants; severe diarrhea; and vegans.
- Switching formulas for excessive crying, spitting up, or gas is rarely helpful.
- Don’t switch formulas without discussing it with your child’s doctor.
Powdered Versus Liquid Formulas:
- Formulas come in 3 forms: concentrated liquid, ready-to-feed liquid and powder.
- 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.
Whole Cow’s Milk, 2% Milk, and Skim Milk
- Whole cow’s milk should not be given to babies before 12 months of age because of the increased risk of iron deficiency anemia and allergies.
- Skim milk or 2% milk should not be given to children before 2 years of age because the fat content of whole milk (3.5%) is needed for rapid brain growth.
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, so vitamin supplements are not needed for infants taking formula.
- From 6 months to 16 years of age, some children need prescription fluoride supplements to prevent dental caries. Note that fluoride is present in the water supplies of most cities, so if you live in an area that has fluoride in its drinking water, your child does not need to take fluoride. If a prescription is needed, discuss with your doctor during office hours.
Water to Mix with Formula
- 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 to avoid potential lead exposure. Heat cold water to the desired temperature then add 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).
- For preparing a larger batch of formula, distilled, bottled, or boiled water is required.
Extra Water
- Babies do not routinely need extra water.
- Excessive water can cause seizures from water intoxication.
- Offer some water if weather is very hot, but only if your baby is over one month old.
- Don’t give any water during your child’s first month.
- Don’t give more than 4 ounces of extra water per day during the first six months of life
- After starting solid foods, infants may need more water.
How Much Formula 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 amount of formula in ounces 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 because it’s now contaminated.
Frequency of Feedings
Babies mainly need to be fed when they are hungry. If they are fussy and more than two 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.
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.
How to Eliminate Night Feedings
Most newborns need to be fed at least twice each night, but 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 more than three 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.
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.
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 because it is considered contaminated.
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.
Burping
- It is not harmful if a baby doesn’t burp, but burping may decrease spitting up.
- Burping can be done twice per feeding – once midway and once at the end.
- If your baby does not burp after one minute of patting, it can be discontinued.
Baby Bottle Tooth Decay
- Some older infants and toddlers have learned to expect their bottle at naptime and bedtime, but severe tooth decay can be caused by falling asleep with a bottle of milk or juice propped up in a baby’s mouth.
- 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.
Traveling
- Using prepackaged bottles of ready-to-feed formula is the easiest but most expensive solution when traveling.
- If using concentrated formula, mix the formula ahead of travel and carry in a cold insulated container
- If using powered formula, put the required number of scoops in a bottle. Carry clean water in a separate bottle. Mix prior to each feeding.
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.
Formula-Fed Stools
- Meconium stools are dark greenish-black, thick and sticky. They normally are passed during the first 3 days of life.
- Transitional stools (a mix of meconium and milk stools) are greenish-brown and looser. They are passed days 4 and 5 of life.
- Milk stools without any meconium present are seen from day 6 onward.
- 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.
