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
  2. 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
  3. 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
  4. 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)
  5. 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
  6. 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
  7. 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
  8. 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)
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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)
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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