All About Formula Feeding

Choosing whether to breastfeed or formula feed their baby is one of the biggest decisions expectant and new parents will make.

A number of health organizations — including the American Academy of Pediatrics (AAP), the American Medical Association (AMA), and the World Health Organization (WHO) — recommend breastfeeding as the best choice for babies. Breastfeeding helps defend against infections, prevent allergies, and protect against a number of chronic conditions.

The AAP recommends that babies be breastfed exclusively for the first 6 months. Beyond that, breastfeeding is encouraged until at least 12 months, and longer if both the mother and baby are willing.

Although experts believe breast milk is the best nutritional choice for infants, breastfeeding may not be possible for all women. For many, the decision to breastfeed or formula feed is based on their comfort level, lifestyle, and specific medical situations.

For mothers who are unable to breastfeed or who decide not to, infant formula is a healthy alternative. Formula provides babies with the nutrients they need to grow and thrive.

Some mothers worry that if they don’t breastfeed, they won’t bond with their baby. But the truth is, loving mothers will always create a special bond with their children. And feeding — no matter how — is a great time to strengthen that bond.

The decision to breastfeed or formula feed your baby is a personal one. Weighing the pros and cons of each method can help you decide what is best for you and your baby.

All About Breastfeeding

Nursing can be a wonderful experience for both mother and baby. It provides ideal nourishment and a special bonding experience that many mothers cherish.

Here are some of the many benefits of breastfeeding:

Fighting infections and other conditions. Breastfed babies have fewer infections and hospitalizations than formula-fed infants. During breastfeeding, antibodies and other germ-fighting factors pass from a mother to her baby and strengthen the immune system. This helps lower a baby’s chances of getting many infections, including:

• ear infections
• diarrhea
• respiratory infections
• meningitis

Breastfeeding also may protect babies against:

• allergies
• asthma
• diabetes
• obesity
• sudden infant death syndrome (SIDS)

Breastfeeding is particularly beneficial for premature babies.

Nutrition and ease of digestion. Often called the “perfect food” for a human baby’s digestive system, breast milk’s components — lactose, protein (whey and casein), and fat — are easily digested by a newborn.

As a group, breastfed infants have less difficulty with digestion than do formula-fed infants. Breast milk tends to be more easily digested so that breastfed babies have fewer bouts of diarrhea or constipation.

Breast milk also naturally contains many of the vitamins and minerals that a newborn requires. One exception is vitamin D — the AAP recommends that all breastfed babies begin receiving vitamin D supplements during the first 2 months and continuing until a baby consumes enough vitamin D-fortified formula or milk (after 1 year of age).

The U.S. Food and Drug Administration (FDA) regulates formula companies to ensure they provide all the necessary nutrients (including vitamin D) in their formulas. Still, commercial formulas can’t completely match breast milk’s exact composition. Why? Because milk is a living substance made by each mother for her individual infant, a process that can’t be duplicated in a factory.

Free. Breast milk doesn’t cost a cent, while the cost of formula quickly adds up. And unless you’re pumping breast milk and giving it to your baby, there’s no need for bottles, nipples, and other supplies that can be costly. Since breastfed babies are less likely to be sick, that may mean they make fewer trips to the doctor’s office, so fewer co-pays and less money are paid for prescriptions and over-the-counter medicines.

Different tastes. Nursing mothers usually need 500 extra calories per day, which means they should eat a wide variety of well-balanced foods. This introduces breastfed babies to different tastes through their mothers’ breast milk, which has different flavors depending on what their mothers have eaten. By tasting the foods of their “culture,” breastfed infants more easily accept solid foods.

Convenience. With no last-minute runs to the store for more formula, breast milk is always fresh and available whether you’re home or out and about. And when women breastfeed, there’s no need to wash bottles and nipples or warm up bottles in the middle of the night.

Smarter babies. Some studies suggest that children who were exclusively breastfed have slightly higher IQs than children who were formula fed.

“Skin-to-skin” contact. Many nursing mothers really enjoy the experience of bonding so closely with their babies. And the skin-to-skin contact can enhance the emotional connection between mother and infant.

Beneficial for mom, too. The ability to totally nourish a baby can help a new mother feel confident in her ability to care for her baby. Breastfeeding also burns calories and helps shrink the uterus, so nursing moms may be able to return to their pre-pregnancy shape and weight quicker. Also, studies show that breastfeeding helps lower the risk of breast cancer, high blood pressure, diabetes, and cardiovascular disease, and also may help decrease the risk of uterine and ovarian cancer.

Breastfeeding Challenges

Breastfeeding can be easy from the get-go for some mothers, but take a while to get used to for others. Moms and babies need plenty of patience to get used to the routine of breastfeeding.

Common concerns of new moms, especially during the first few weeks and months, may include:

Personal comfort. Initially, many moms feel uncomfortable with breastfeeding. But with proper education, support, and practice, most moms overcome this.

Latch-on pain is normal for the first week to 10 days, and should last less than a minute with each feeding. But if breastfeeding hurts throughout feedings, or if their nipples and/or breasts are sore, it’s a good idea for breastfeeding mothers to get help from a lactation consultant or their doctor. Many times, it’s just a matter of using the proper technique, but sometimes pain can mean that something else is going on, like an infection.

Time and frequency of feedings. Breastfeeding requires a big time commitment from mothers, especially in the beginning, when babies feed often. A breastfeeding schedule or the need to pump breast milk during the day can make it harder for some moms to work, run errands, or travel.

And breastfed babies do need to eat more often than babies who take formula, because breast milk digests faster than formula. This means mom may find herself in demand every 2 or 3 hours (maybe more, maybe less) in the first few weeks.

Diet. Women who are breastfeeding need to be aware of what they eat and drink, since these can be passed to the baby through the breast milk. Just like during pregnancy, breastfeeding women should not eat fish that are high in mercury and limit consumption of lower mercury fish.

If a mom drinks alcohol, a small amount can pass to the baby through breast milk. She should wait at least 2 hours after a single alcoholic drink to breastfeed to avoid passing any alcohol to the baby. Caffeine intake should be kept to no more than 300 milligrams (about one to three cups of regular coffee) or less per day because it can cause problems like restlessness and irritability in some babies.

Maternal medical conditions, medicines, and breast surgery. Medical conditions such as HIV or AIDS or those that involve chemotherapy or treatment with certain medicines can make breastfeeding unsafe. A woman should check with her doctor or a lactation consultant if she’s unsure if she should breastfeed with a specific condition. Women should always check with the doctor about the safety of taking medicines while breastfeeding, including over-the-counter and herbal medicines.

Mothers who’ve had breast surgery, such as a reduction, may have difficulty with their milk supply if their milk ducts have been severed. In this situation, a woman should to talk to her doctor about her concerns and work with a lactation specialist.

All About Formula Feeding

Commercially prepared infant formulas are a nutritious alternative to breast milk, and even contain some vitamins and nutrients that breastfed babies need to get from supplements.

Manufactured under sterile conditions, commercial formulas attempt to duplicate mother’s milk using a complex combination of proteins, sugars, fats, and vitamins that aren’t possible to create at home. So if you don’t breastfeed your baby, it’s important to use only commercially prepared formula and not try to make your own.

Besides medical concerns that may prevent breastfeeding, for some women, breastfeeding may be too difficult or stressful. Here are other reasons women may choose to formula feed:

Convenience. Either parent (or another caregiver) can feed the baby a bottle at any time (although this is also true for women who pump their breast milk). This allows mom to share the feeding duties and helps her partner to feel more involved in the crucial feeding process and the bonding that often comes with it.

Flexibility. Once the bottles are made, a formula-feeding mother can leave her baby with a partner or caregiver and know that her little one’s feedings are taken care of. There’s no need to pump or to schedule work or other obligations and activities around the baby’s feeding schedule. And formula-feeding moms don’t need to find a private place to nurse in public.

Time and frequency of feedings. Because formula is less digestible than breast milk, formula-fed babies usually need to eat less often than breastfed babies.

Diet. Women who opt to formula feed don’t have to worry about the things they eat or drink that could affect their babies.

Formula Feeding Challenges

As with breastfeeding, there are some challenges to consider when deciding whether to formula feed.

Lack of antibodies. None of the antibodies found in breast milk are in manufactured formula. So formula can’t provide a baby with the added protection against infection and illness that breast milk does.

Can’t match the complexity of breast milk. Manufactured formulas have yet to duplicate the complexity of breast milk, which changes as the baby’s needs change.

Planning and organization. Unlike breast milk — which is always available, unlimited, and served at the right temperature — formula feeding your baby requires planning and organization to make sure that you have what you need when you need it. Parents must buy formula and make sure it’s always on hand to avoid late-night runs to the store.

And it’s important to always have the necessary supplies (like bottles and nipples) clean, easily accessible, and ready to go — otherwise, you will have a very hungry, very fussy baby to answer to. With 8-10 feedings in a 24-hour period, parents can quickly get overwhelmed if they’re not prepared and organized.

Expense. Formula can be costly. Powdered formula is the least expensive, followed by concentrated, with ready-to-feed being the most expensive. And specialty formulas (such as soy and hypoallergenic) cost more — sometimes far more — than the basic formulas. During the first year of life, the cost of basic formula can run about $1,500.

Possibility of producing gas and constipation. Formula-fed babies may have more gas and firmer bowel movements than breastfed babies.

Making a Choice

Deciding how you will feed your baby is not an easy decision to make. You’ll really only know the right choice for your family once your baby comes.

Many women decide on one method before the birth and then change their minds once their baby is born, or in the weeks or months after. And many women decide to breastfeed and supplement with formula because they find that is the best choice for their family and their lifestyle.

While you’re weighing the pros and cons, talk to your doctor or lactation consultant. These health care providers can give you more information about the options available and help you make the best decision for your family.

Feeding a baby is an exciting experience for any new parent. It can also be a little intimidating, especially if you don’t know what to expect. So here’s a quick guide to an important aspect of feeding — burping.

Burping helps to get rid of some of the air that babies tend to swallow during feeding. In some babies, not being burped frequently and too much swallowed air can lead to spitting up, crankiness, and gassiness.

How to Burp Your Baby

When burping your baby, repeated gentle patting on your baby’s back should do the trick — there’s no need to pound hard. To prevent messy cleanups when your baby spits up or has a “wet burp,” you might want to place a towel or bib under your baby’s chin or on your shoulder.

Try experimenting with different positions for burping that are comfortable for you and your baby. Many parents prefer to use one of these three methods:

1. Sit upright and hold your baby against your chest. Your baby’s chin should rest on your shoulder as you support the baby with one hand. With the other hand, gently pat your baby’s back. Sitting in a rocking chair and gently rocking with your baby while you do this may also help.
2. Hold your baby sitting up, in your lap or across your knee. Support your baby’s chest and head with one hand by cradling your baby’s chin in the palm of your hand and resting the heel of your hand on your baby’s chest (but be careful to grip your baby’s chin, not throat). Use the other hand to pat your baby’s back gently.
3. Lay your baby on your lap on his or her belly. Support your baby’s head and make sure it’s higher than his or her chest. Gently pat your baby’s back.

If your baby seems fussy while feeding, stop the session, burp your baby, and then begin feeding again. Try burping your baby every 2 to 3 ounces (60 to 90 milliliters) if you bottle-feed and each time you switch breasts if you breastfeed.

If your baby tends to be gassy, spits a lot, has gastroesophageal reflux disease (GERD), or seems fussy during feeding, try burping your baby every ounce during bottle-feeding or every 5 minutes during breastfeeding. If your baby doesn’t burp after a few minutes, change the baby’s position and try burping for another few minutes before feeding again. Always burp your baby when feeding time is over.

For the first 6 months or so, keep your baby in an upright position for 10 to 15 minutes (or longer if your baby spits up or has GERD) after feeding to help prevent the milk from coming back up. But don’t worry if your baby spits sometimes. It’s probably more unpleasant for you than it is for your baby.

Sometimes your baby may awaken because of gas — simply picking your little one up to burp might put him or her back to sleep. As your baby gets older, you shouldn’t worry if your child doesn’t burp during or after every feeding. Usually, it just means that your baby has learned to eat without swallowing excess air.

Babies with colic (3 or more hours a day of continued crying) might also have gas from swallowing too much air during crying spells, which can make the baby even more uncomfortable. Using anti-gas drops has not proven to be an effective way to treat colic or gas, and some available medications can be dangerous.

How you feed your newborn is the first nutrition decision you will make for your child. These guidelines on breastfeeding and bottle feeding can help you make the decision that’s right for you and your baby.

Breast or Bottle?

Medical experts say breastfeeding is best for newborns. Specifically, the American Academy of Pediatrics (AAP) recommends that babies be breastfed exclusively for about the first 6 months. Following the introduction of solid foods, breastfeeding should continue through the first year of life and even beyond, if desired.

But breastfeeding might not be possible or preferable for all new moms. Deciding to breastfeed or bottle feed a baby is usually based on the mother’s comfort level with breastfeeding as well as her lifestyle. In some cases, breastfeeding may not be recommended for a mom and her baby. If you have any questions about whether to breastfeed or formula feed, talk to your pediatrician.

Remember, your baby’s nutritional and emotional needs will be met whether you choose to breastfeed or formula feed.

About Breastfeeding

Breastfeeding your newborn has many advantages. Perhaps most important, breast milk is the perfect food for a human baby’s digestive system. It has the nutrients that a newborn needs, and all of its components — lactose, protein (whey and casein), and fat — are easily digested. Commercial formulas try to imitate breast milk, and come close, but cannot match its exact composition.

Also, breast milk contains antibodies that help protect babies from a wide variety of infectious illnesses, including diarrhea and respiratory infections. Studies suggest that breastfed babies are less likely to develop certain medical problems, including diabetes, high cholesterol, asthma, and allergies. Breastfeeding also may decrease the chances that a child will become overweight or obese.

Breastfeeding is great for moms, too. It burns calories and helps shrink the uterus, so nursing moms get back in shape quicker. Breastfeeding also may protect mom from breast and ovarian cancer.

Some moms find breastfeeding easier and quicker than formula feeding; it needs no preparation and you don’t run out of breast milk in the middle of the night. Also, breastfeeding costs little. Nursing mothers do need to eat more and may want to buy nursing bras and pads, a breast pump, or other equipment. But these expenses are generally less than the cost of formula.

Breastfeeding meets a variety of emotional needs for both moms and babies — the skin-to-skin contact can enhance the emotional connection, and providing complete nourishment can help a new mother feel confident in her ability to care for her newborn.

Limitations of Breastfeeding

With all the good things known about breastfeeding, why doesn’t every mother choose to breastfeed?

Breastfeeding requires a big commitment from a mother. Some new moms feel tied down by the demands of a nursing newborn. Since breast milk is easily digested, breastfed babies tend to eat more often than babies who are fed formula. This means mom may find herself in demand as often as every 2 or 3 hours in the first few weeks. This can be tiring, but it’s not long before babies feed less frequently and sleep longer at night.

Some new mothers need to get back to work outside the home or separate from their babies from time to time for other reasons. Some of these moms opt for formula feeding so other caregivers can give the baby a bottle. Mothers who want to continue breastfeeding can use a breast pump to collect breast milk to be given in a bottle so their babies still get its benefits even when mom isn’t available to breastfeed.

Other family members (dads most of all) may want to share in this most fundamental of baby care routines and participate in feeding the baby. When mom is breastfeeding, dad or siblings may want to stay close by. Helping mom get comfortable, or providing a burp cloth when needed, will let them be part of the experience.

Once breastfeeding is established, other family members can help out by giving the baby pumped breast milk in a bottle when mom needs a break.

Sometimes a woman may feel embarrassed or apprehensive about the prospect of breastfeeding. These feelings usually disappear once a successful breastfeeding process is set. It’s often helpful to seek advice from those who’ve gone through the experience. Most hospitals and birthing centers can provide in-depth instruction on breastfeeding techniques to new mothers.

Your pediatrician, nurse practitioner, or nurse can answer questions or put you in touch with a lactation consultant or a breastfeeding support group.

In some cases, a mother’s health may interfere with her ability to breastfeed. For example, mothers undergoing chemotherapy for cancer and moms who are infected with human immunodeficiency virus (HIV, the virus that causes AIDS) should not breastfeed.

If you have a medical condition or take any medicines regularly, or if you or your baby gets sick, talk with your doctor about whether it’s OK to breastfeed. If you have to stop nursing temporarily, it’s important to continue to pump breast milk to maintain milk production.

In some situations, it may not possible to breastfeed, such as when a baby is sick or born prematurely. Mothers should talk with their baby’s doctor about expressing and storing milk. Even if the infant cannot breastfeed, breast milk may be given via a feeding tube or bottle.

Sometimes mothers who have inverted nipples may have difficulty breastfeeding, but with the help of a lactation consultant this usually can be overcome. Likewise, women who have had plastic surgery on their breasts should be able to successfully breastfeed. Be sure to speak to your doctor if you have any concerns.

Avoid using pacifiers or bottles until breastfeeding is established, usually after the first month of life. Introducing them before breastfeeding is known to cause “nipple confusion,” and can lead to an infant giving up the breast.

About Formula Feeding

Commercially prepared infant formula is a nutritious alternative to breast milk. Bottle feeding can offer more freedom and flexibility for moms, and it makes it easier to know how much the baby is getting.

Because babies digest formula more slowly than breast milk, a baby who is getting formula may need fewer feedings than one who breastfeeds. Formula feeding also can make it easier to feed the baby in public, and allows the father and other family members to help feed the baby, which can enhance bonding.

Limitations of Formula Feeding

Just as breastfeeding has its unique demands, so does bottle feeding. Bottle feeding can require a great deal of organization and preparation, especially if you want to take your baby out. Also, formula can be pretty expensive.

It’s important to make sure that you have enough formula on hand, and bottles that are clean and ready to be used.

Here are a few key guidelines for formula feeding:

• Be sure to carefully follow directions on the label when preparing formula.
• Bottles left out of the refrigerator longer than 1 hour and any formula left in the bottle that a baby doesn’t finish should be discarded.
• Prepared bottles of formula should be stored in the refrigerator for no longer than 24 hours and can be carefully warmed just before feeding. You don’t have to warm formula but most babies prefer it.
• A bottle of formula can be warmed by holding it in running warm water or setting it in a pan of warm water. A bottle of formula (or breast milk) should never be warmed in a microwave. The bottle can heat unevenly and leave “hot spots” that can burn a baby’s mouth.

Is My Newborn Getting Enough to Eat?

Your newborn will nurse about 8 to 12 times per day during the first weeks of life. In the beginning, mothers may want to try nursing 10-15 minutes on each breast, then adjust the time as necessary.

Breastfeeding should be “on demand” (when your baby is hungry), which is generally every 1-3 hours. As newborns get older, they’ll nurse less often and have longer stretches between feedings. Newborn babies who are getting formula will likely take about 2-3 ounces every 2-4 hours. Newborns should not go more than about 4 to 5 hours without feeding.

Most experts suggest you nurse or feed your baby whenever he or she seems hungry. Signs that babies are hungry include:

• moving their heads from side to side
• opening their mouths
• sticking out their tongues
• placing their hands and fists to their mouths
• puckering their lips as if to suck
• nuzzling again their mothers’ breasts
• showing the rooting reflex (when a baby moves its mouth in the direction of something that’s stroking or touching its cheek)

A rigid feeding schedule is not necessary; you and your baby will eventually establish your unique feeding pattern. Babies know (and will let their parents know) when they’re hungry and when they’ve had enough. Watch for signs that your baby is full (slow, uninterested sucking; turning away from the breast or bottle) and stop the feeding once these signs appear.

As babies grow, they begin to eat more at each feeding and can go longer between feedings. There may be other times when your infant seems hungrier than usual. Continue to nurse or feed on demand. Nursing mothers need not worry — breastfeeding stimulates milk production and your supply of breast milk will adjust to your baby’s demand for it.

New mothers are often concerned that their babies may not be getting enough to eat. It’s important for all infants to be seen by their pediatrician within 3 to 5 days after birth and within 48 to 72 hours after a mother and newborn leave the hospital. During this visit, the baby will be weighed and examined, and feeding questions and concerns can be addressed.

You can be assured that your baby is getting enough to eat if he or she seems satisfied, produces about six to eight wet diapers a day, has regular bowel movements, sleeps well, is alert when awake, and is gaining weight. A baby who is fussing, crying, seems hungry, and does not appear satisfied after feeding may not be getting enough to eat. If you’re concerned that your baby isn’t getting enough to eat, call your doctor.

Many infants “spit up” a small amount after eating or during burping, but a baby should not vomit after feeding. This can be due to overfeeding, but vomiting after every feeding may be a sign of an allergy, digestive problem, or other problem that needs medical attention. If you have concerns that your baby is spitting up too much, call your doctor.

Nutritional Supplements

Breast milk contains the right combination of vitamins and easily absorbed iron that will be sufficient until your baby begins eating iron-rich foods around 6 months of age.

A healthy infant being nursed by a healthy mother does not need any additional vitamins or nutritional supplements, with the exception of vitamin D. Breast milk does contain some vitamin D, and vitamin D is produced by the body when the skin is exposed to sunlight. However, sun exposure increases the risk of skin damage, so parents are advised to minimize exposure.

The AAP recommends that all breastfed babies begin receiving vitamin D supplements within the first few days of life, continuing until they get enough vitamin D-fortified formula or milk (after 1 year of age).

Iron-fortified formula contains the right blend of vitamins and minerals for a baby, so supplements are usually not necessary. Infants drinking less than 1 liter, or about a quart, of formula a day may need additional vitamin D supplementation.

Water, juice, and other foods usually aren’t necessary during a baby’s first 6 months. Breast milk or formula provides everything babies need nutritionally until they start eating solid foods. Talk to your doctor if you have any questions about feeding your newborn.

Whether you’ve decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you’re bound to have questions. Here are answers to some common queries about formula feeding.

What supplies do I need?

From formula to bottles, from nipples to sterilizers, the choices can seem endless. But before your baby is born, it’s a good idea to hold off buying — or registering for — too much of any one type of feeding product. After all, you may end up having to return them when you find that your baby doesn’t like what you’ve chosen.

To get you through the first week or so, you’ll need to have enough formula, water, bottles, and nipples. Burp cloths and a bottle/nipple brush will also come in handy.

Once you get in the swing of feeding your baby, you may find it’s worth investing in more or different kinds of bottles, or items that can make the feeding process go a little smoother (like a bottle drying rack). A bottle sterilizer is not necessary, but you should sterilize all feeding supplies before the first use.

What type of formula should I use?

Many different formulas (at a wide variety of prices) are available these days, which can make the process of choosing one a little overwhelming at first.

Ask your doctor about which brands might be best for your baby. You also can talk to other parents of infants about what they use and why. But remember, it’s ultimately up to your baby.

The many kinds of formula available today include:

• Cow’s milk-based formulas, which make up the vast majority of formulas. Most milk-based formulas have added iron, which babies need. Use only iron-fortified formula, unless advised otherwise by your doctor.
• Soy-based formulas, for parents who do not want their babies to eat animal protein, or for the very rare babies who cannot digest lactose. Many babies who are allergic to cow’s milk also are allergic to the protein in soy formulas, so soy-based formulas generally don’t help with milk-protein allergies. Use only iron-fortified formula, unless advised otherwise by your doctor.
• Hypoallergenic formulas for babies who can’t tolerate the basic formulas, like those with allergies to milk or soy proteins. The proteins in these hypoallergenic formulas are broken down to their basic components and so are easier to digest.
• Specialized formulas designed for premature, low birth-weight babies.

Most formulas comes in three basic forms:

1. Powders that require mixing with water and are the least expensive.
2. Concentrates, which are liquids that require diluting with water.
3. Ready-to-use (or ready-to-feed) liquids that can be poured right into bottles. These are the most expensive but are convenient if you’re traveling or can’t get to a sterile water supply quickly.

All formulas manufactured in the United States have to meet strict nutritional standards from the U.S. Food and Drug Administration (FDA), so just because a formula is name brand (versus generic) doesn’t necessarily mean that it’s the best for your baby.

Whatever kind you choose, make sure to check the expiration date on all cans and bottles of formula, and don’t use formula from leaky, dented, or otherwise damaged containers.

What about formula with DHA or ARA?

DHA (docosahexaenoic acid) and ARA (arachidonic acid) are ingredients that can be found in some, but not all, formulas.

DHA and ARA are polyunsaturated fatty acids (considered the “good” kinds of fat) that may be linked to brain and nerve development and can be found naturally in fish oils and eggs. The fatty acids are also found in breast milk. By putting DHA and ARA in infant formulas, the manufacturers are attempting to imitate breast milk.

But is it beneficial to buy an infant formula with these ingredients? The jury still seems to be out on that. Some studies have indicated that formulas supplemented with DHA and ARA benefit visual and cognitive development. But others haven’t shown any significant improvement with DHA and ARA formulas.

What kind of bottle should I use?

Bottles come in different shapes and sizes, can be made of glass or plastic, and may be reusable or have disposable liners inside. Some babies do better with certain shapes or bottles with liners on the inside. You may need to try a few different brands before you find the one that works best for you and your baby.

It’s important to note that some plastic bottles are labeled “BPA-free”— meaning that they do not contain the chemical bisphenol A, which is found in some plastics and may affect kids’ health. Glass bottles are free of BPA and can last for a long time, but can crack and chip, so they need to be checked often to avoid harm to your baby.

What kind of nipple should I use?

Walk down the nipple aisle in your local baby center and it’s easy to be completely overwhelmed. For starters, nipples come in silicone (clear) or latex (brown). But the options don’t end there.

The many different varieties include orthodontic nipples, rounded nipples, wide-based nipples, and flat-top nipples, just to name a few. And some are advertised as “being closer to the natural shape of a mother’s breast.” But which kind is best really depends on your baby and what he or she seems to prefer. After all, every baby is different.

Nipples also often come in different numbers, “stages,” or “flow rates” to reflect the size of the nipple’s hole, which affects the flow (i.e., slow, medium, or fast) of formula or breast milk. For example, fast flows may cause younger babies to gag or may simply give them more than they can handle, whereas slower flows may frustrate some babies and cause them to suck harder and gulp too much air.

But whether these different flows are necessary depends on each baby. Your little one may seem to prefer variety or may be content throughout infancy to use the same kind and size of nipple. If your baby seems fussy or frustrated with the nipple, you can certainly try a different kind (like one with a larger hole) to see if it makes any difference.

How often should nipples be replaced?

That depends on how the nipples you’re using hold up to cleaning, sterilizing, and everyday use. Be sure to check them regularly for signs of wear and replace them often. Also, as your baby grows, he or she might prefer nipples that come in different sizes and flows (the holes get bigger as babies get older and are ready to handle faster flows of milk).

Formula can be pricey. Any way to cut costs?

Just as you may do already for your groceries and other baby supplies, shop around for the best deals on the formula you’ve chosen:

• Take advantage of all of the free samples and coupons you get in the mail the first few months after your delivery. Many times, new moms are placed on mailing lists for everything baby-related, from children’s book clubs to formula companies.
• Clip coupons. You may even want to save some for different kinds of formula, in case you end up changing your baby’s formula for some reason.
• See if your child’s daycare has a coupon exchange program in which parents bring in their coupons and other moms and dads take what they need.
• Sign up for online coupon clubs that allow you to print and save coupons for only the things you indicate you need.
• Sign up for formula companies’ clubs and special programs (through the mail or online) that may offer discounts, coupons, and/or free formula and other products.
• Compare prices on formula at online retailers. Some online stores have special “mom” clubs that allow you to save regularly on certain products every month, especially if you join a subscription service.
• Check for specials at your local grocery stores and/or baby retailer.
• See if your local wholesale/bulk items store offers your baby’s formula for cheaper than local grocery stores. But don’t automatically expect it to be less expensive in the long run just because it comes in a bigger container. When you’re buying in bulk — or in bigger sizes — be sure to do the math on how much you’re spending per ounce. Sometimes, it may seem like a deal when it really isn’t.

Whether you’ve decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you’re bound to have questions. Here are answers to some common queries about formula feeding.

How often should I feed my baby?

It’s generally recommended that babies be fed whenever they seem hungry, which is called demand feeding (or feeding on demand).

Most newborns who are formula-fed feed every 2 to 3 hours. As they get bigger and their tummies can hold more milk they usually eat every 3 to 4 hours.

And if your baby is very young, or having problems gaining weight, you shouldn’t go too long without feeding, even if it means waking your baby. In this case, talk to your doctor about how often your baby should be fed.

How do I know my baby is hungry?

Signs that babies are hungry include:

• moving their heads from side to side
• opening their mouths
• sticking out their tongues
• placing their hands, fingers, and fists to their mouths
• puckering their lips as if to suck
• nuzzling again their mothers’ breasts
• showing the rooting reflex (when a baby moves its mouth in the direction of something that’s stroking or touching its cheek)
• crying

Despite what you might think, crying is a late sign of hunger. You should give a feeding before your baby gets so hungry that he or she gets upset and becomes difficult to calm down.

It’s also important, however, to realize that every time your baby cries it is not necessarily because of hunger. Sometimes babies just need to be cuddled or changed. Or they could be overstimulated, bored, or too hot or too cold. If your baby cries only an hour after a good feeding, there may be something else causing the distress.

How much should my baby drink?

In the first few weeks, mix 2- to 3-ounce (60- to 90-milliliter) bottles for your newborn. Gradually increase this amount as you become familiar with your baby’s eating patterns and appetite. Here’s a general look at how much your baby may be eating at different stages:

• On average, a newborn drinks about 1.5-3 ounces (45-90 milliliters) every 2-3 hours. This amount increases as your baby grows and is able to take more at each feeding.
• At about 2 months, your baby may be taking 4-5 ounces (120-150 milliliters) at each feeding and the feedings may be every 3-4 hours.
• At 4 months, your baby may be taking 4-6 ounces (120-180 milliliters) at each feeding, depending on the frequency of feedings and his or her size.
• By 6 months, your baby may be taking 6-8 ounces (180-230 milliliters) every 4 to 5 hours. This also depends on whether you’ve introduced any baby food.

Why does my baby seem hungrier than usual?

As babies gain weight, they should begin to eat more at each feeding and go longer between feedings. Still, there may be times when your little one seems hungrier than usual.

Your baby may be going through a period of rapid growth (called a growth spurt). These can happen at any time, but in the early months growth spurts often occur at around:

• 7-14 days old
• between 3-6 weeks
• 4 months
• 6 months

During these times and whenever your baby seems especially hungry, follow his or her hunger cues and continue to feed on demand, increasing the amount of formula you give as needed.

Is my baby eating enough?

Babies grow at different rates, and at times you may wonder whether your baby is getting enough nutrients to develop properly. To help determine whether your baby is eating enough, follow the schedule of regular well-child checkups so that your little one can be weighed and measured.

In the meantime, your newborn’s diapers are a good indicator of whether your baby is getting enough to ear. You’ll probably be changing at least six wet and four dirty (soiled or “poopy”) diapers each day at first.

Newborns’ poop is thick and tarry in the beginning and then becomes more yellow or green as they get older. Formula-fed babies often have firmer, less seedy stools than breast-fed babies.

Wet diapers should have clear or very pale urine. If you see orange crystals in a wet diaper, contact your baby’s doctor. Crystals are usually not a cause for concern, but sometimes they can be a sign of a baby not getting enough fluid or of dehydration. Other possible signs of underfeeding include:

• not gaining enough weight
• seeming unsatisfied, even after a complete feeding

If you’re concerned or notice any signs that your baby isn’t getting enough nutrition, call your doctor.

Whether you’ve decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you’re bound to have questions. Here are answers to some common queries about formula feeding.

Do I need to sterilize my baby’s bottles?

Before the first use, you’ll need to sterilize nipples and bottles in a rolling boil for 5 minutes. You can also sterilize them with a store-bought countertop or microwaveable sterilizer, but boiling works just as well and costs nothing.

After that, it’s not necessary to sterilize your baby’s bottles and supplies each time you feed your baby. You will need to wash bottles and nipples in hot, soapy water (or run them through the dishwasher) after every use. They can transmit bacteria if not cleaned properly.

How do I prepare my baby’s bottles?

Prepare your baby’s formula by mixing water and the appropriate amount of powdered infant formula. The packaging on the side of the formula container will tell you how much to use. Carefully follow the directions. You can use tepid (room temperature) tap water, as long as your local or state health departments have labeled it as safe to drink.

If you’re concerned about your water, you may sterilize it to kill germs. Here’s how:

• pour cold tap water into a teapot or saucepan
• place pot on the stove over medium heat
• bring water to a rolling boil, and let boil for about a minute
• let the water cool until it’s at room temperature

Test to see if the water is cool enough for your baby to drink by shaking a few drops of water on the inside of your wrist. If it stings, it’s still too hot. Once water has cooled, don’t let it sit longer than 30 minutes before adding it to the formula.

Once prepared, the formula is ready to feed to your baby immediately without additional refrigeration or warming. Formula that’s been prepared should be consumed or stored in the refrigerator within 1 hour. If it has been at room temperature for more than 1 hour, throw it away. And if your baby doesn’t drink all the formula in the bottle, throw away the unused portion — do not save it for later.

Formula may be prepared ahead of time (for up to 24 hours) if you store it in the refrigerator to prevent the formation of bacteria. Open containers of ready-made formula, concentrated formula, and formula prepared from concentrate also can be stored safely in the refrigerator for up to 48 hours.

How do I warm my baby’s bottles?

Some babies may actually prefer cold or room-temperature bottles to warm, especially if you start serving them that way from the get-go (which can make things easier for you in the long run).

But if your baby does prefer a warm bottle, remember that the microwave can create dangerous “hot spots” in bottles, so you should never microwave formula.

Instead, you can:

• Run the bottle under very warm or hot water for a few minutes.
• Put your baby’s bottles in a pan of hot water. Just be sure to remove the pan from the heat source before placing the bottle in it.
• Use bottle warmers that either sit on your countertop at home or plug into your car’s lighter.

Whichever way you choose to heat your baby’s bottles, be sure to shake the bottle vigorously. Then test the temperature of the formula by squirting a drop or two on the inside or your wrist before feeding your baby. It should be lukewarm (barely warm) not hot.

When should I prepare the bottles?

Some parents opt to make a bottle just before each feeding, but many others choose to pre-make and refrigerate enough to use for the day. If you know your baby eats every 3-4 hours, for instance, you can make six to eight bottles to last you all day.

If your baby is staying with a caregiver for a long period of time, you may want to prepare just one or two bottles and leave instructions and supplies (bottles, nipples, formula, and water, if necessary) so the caregiver can prepare bottles as needed and not waste any formula. After all, you’ll need to throw away any mixed formula that is not used after 24 hours.

How long can mixed formula keep in the fridge?

You should always refrigerate any bottles you fill for later feedings to prevent bacteria from growing, as well as any open containers of ready-to-feed or concentrate formula. Throw away any mixed formula after 24 hours and any open ready-to-feed or concentrate formula after 48 hours.

How long can a bottle keep at room temperature?

Discard any prepared or ready-to-feed formula that’s been sitting out after 1 hour.

If formula is left over, can I offer it again?

No, throw away any leftover formula. There’s a chance bacteria may have formed since the last feeding, which could make your baby sick.

Whether you’ve decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you’re bound to have questions. Here are answers to some common queries about formula feeding.

My baby is fussy after a feeding. How can I help?

Babies can be fussy for a number of reasons. Sometimes it’s due to gas, or the the type of formula, bottle, or nipple used, or something else entirely. The tips below may help your baby feel more comfortable.

• Walk with your baby or sit in a rocking chair, trying various positions.
• Try burping your baby more often during feedings.
• Place your baby belly-down across your lap and rub his or her back.
• Put a warm towel or warm water bottle on your baby’s belly, checking first to make sure it’s not too hot.
• Hold your baby upright.
• Put your baby in a swing — the motion may have a soothing effect.
• Put your baby in an infant car seat in the back of the car and go for a ride. The vibration and movement of the car often calm a baby.
• Try playing music — some babies respond to sound as well as movement.
• Try turning on the dishwasher, clothing dryer, or a white noise machine. The continuous gentle noise may sooth a crying baby.

If your baby continues to be fussy after feedings, talk to the doctor to see what else may be going on. Gastroesophageal reflux disease (GERD), a milk allergy, or another condition can cause fussiness after a feeding.

How do I know if my baby has an allergy?

Some babies are allergic to the protein in cow’s milk formula. Symptoms of an allergic reaction may include:

• vomiting
• diarrhea
• abdominal pain
• rash
• blood or mucus in the baby’s stools

Report any of these symptoms to your baby’s doctor, and follow his or her advice on switching to a special hypoallergenic formula. But even if the doctor suspects an allergy, don’t spend too much time worrying that your child might be allergic forever. Kids often outgrow milk protein allergies within a few years.

Is soy formula safe for my baby?

Most doctors usually recommend giving babies cow’s milk formula unless there seems to be an allergy or intolerance, in which case the doctor may recommend soy or hypoallergenic formula. Soy formula — with added iron — is as nutritious as cow’s milk-based formula. The problem is that many babies who are allergic to cow’s milk are also allergic to the protein in soy formulas, so it may not be helpful in these cases.

Some parents may worry after hearing or reading about certain soy concerns, particularly about phytoestrogens (hormone-like chemicals from plants) that are found in soy formulas. These concerns need to be studied further, but so far research has not found definite evidence that soy formulas negatively affect a child’s development or reproductive system.

Soy formula should be used under the direction of your doctor, but it can be an alternative to cow’s milk formula for full-term infants. However, soy formulas are not recommended for premature infants.

How do I safely switch to a different formula?

Before making the decision to switch, be sure to talk to your doctor. Parents often assume that formula plays a part in a baby’s fussiness, gas, spitting up, or lack of appetite. But often that’s not the case.

If your doctor gives the OK to switch formulas, he or she will recommend a way to do it so that your baby’s feedings and digestion aren’t interrupted. The doctor may suggest mixing the two formulas together little by little, then eventually eliminating the original formula altogether.

Do I need to give my formula-fed baby vitamins?

No. Commercial infant formulas with iron are manufactured to contain all the nutrients your baby needs.

Does my baby need fluoride supplements?

Infants —whether breastfed or formula-fed — do not need fluoride supplements during the first 6 months. From 6 months to 3 years, babies require fluoride supplements only if the water supply is lacking in fluoride. Ask your doctor about what your little one needs.

Is it normal for my baby to spit up after a feeding?

Yes, many infants will spit up a little after eating or during burping because their digestive tracts are immature. This is perfectly normal. Babies may spit up when they:

• have eaten too much
• burp (the so-called “wet burp”)
• drool
• cough or cry

Some babies spit up often, maybe even after every feeding. If they’re happy, growing normally, and don’t seem troubled by it, this usually is OK. These babies are called “happy spitters.” If you find that your “spitter” seems fussy or uncomfortable after feedings, talk to your doctor to help figure out what’s going on. It helps to keep a record of exactly how often and how much your baby spits up to help your doctor diagnose any problem.

Also tell the doctor if your child vomits. Vomiting is not the same as spitting up. Vomiting is a forceful projection of stomach fluids whereas spitting up is a more gentle “flow” of fluids that come up. In rare cases, vomiting is caused by a problem that needs medical attention.

If the doctor says your baby’s spitting up is normal, here are some ways that may help ease it:

• Burp your little one every 3 to 5 minutes during feedings.
• Try giving smaller feedings more frequently.
• Hold your baby upright after feedings.
• Don’t jiggle, bounce, or actively play with your baby right after feedings.
• Make sure the nipple hole in your baby’s bottle is the right size for your baby. For example, fast flows may cause babies to gag or may simply give them more than they can handle, whereas slower flows may frustrate some babies and cause them to suck harder and gulp too much air.
• Keep your baby’s head above his or her feet while feeding (in other words, don’t hold your baby in a dipped-down position when feeding).
• Raise the head of your baby’s crib or bassinet. Do this by rolling up a few small hand towels or receiving blankets (or buy special wedges) to place under (not on top of) the mattress. But don’t use a pillow under your baby’s head, and always put your baby on his or her back to sleep.

Fortunately, many babies grow out of spitting up by the time they’re 1 year old.

Is it OK to prop a bottle in my baby’s mouth?

No. You shouldn’t leave your baby unattended or feeding from a “propped” bottle. Propping a bottle is a choking hazard and also can lead to ear infections and baby bottle tooth decay, a serious dental condition that results from formula (as well as breast milk or juice) pooling in a baby’s mouth. Always hold your baby during feedings.

It is OK to let my baby sleep with a bottle?

No. You should never put your baby to bed with a bottle. Like propping a bottle, it can cause choking, ear infections, and tooth decay.

Whether you’ve decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you’re bound to have questions. Here are answers to some common queries about formula feeding.

When should I introduce solid foods and juice?

The best time to introduce solid foods is when your baby has developed the skills needed to eat. This usually happens between the ages of 4 and 6 months. How do you know when your baby is ready?

Babies who are ready to eat solids foods:

• are interested in foods (for example, they may watch others eat, reach for food, and open their mouths when food approaches)
• hold up their heads well, and sit up with little or no help
• have the oral motor skills needed to eat (meaning that they don’t push food of the mouth but move it to the throat and swallow it)
• usually weigh twice their birth weight, or close to it

Wait until your baby is at least 4 months old and shows these signs of readiness before introducing solids. Babies who start solid foods before 4 months are at a higher risk of becoming obese.

When the time is right, start with a single-grain, iron-fortified cereal for babies (rice cereal has traditionally been the first food for babies, but you can start with any you prefer). Start with one or two tablespoons of cereal mixed with formula to achieve the right consistency. (As an alternative, you can give an iron-rich puréed meat.) Feed your baby with a small baby spoon, and never add cereal to a baby’s bottle unless your doctor instructs you to do so.

At this stage, solids should be fed after a bottle-feeding session, not before. That way, your baby fills up on formula, which should still be your baby’s main source of nutrients until age 1.

Once your baby gets the hang of eating cereal, introduce a variety of puréed fruits, vegetables, and meats. Wait a few days between introducing a new food to make sure your baby doesn’t have an allergic reaction.

Note: There is no benefit to offering fruit juice, even to older babies. Juice can fill them up and leave little room for more nutritious foods, promote obesity, cause diarrhea, and even put a baby at an increased risk for cavities when teeth start coming in.

When can I start giving my baby cow’s milk?

Before their first birthday, babies still need the nutrients in breast milk or formula. But at 1 year old, your baby can try whole cow’s milk. Why not skim or 2%? Because babies need the fat in whole milk for normal growth and brain development during the busy early toddler period.

You can transition your baby from formula to whole milk by beginning to replace bottles of formula with bottles — or sippy cups — of milk. By 1 year old, your baby should be eating a variety of other foods and only 2-3 cups (480-720 milliliters) of milk per day.

If your baby was put on a soy or hypoallergenic formula because of a milk allergy, talk to your doctor before introducing milk.

When can I start giving my baby water?

In their first few months, babies usually don’t need extra water. On very hot days, most babies do well with additional feedings. But you may want to offer your infant water, especially if your baby’s pee is dark or your baby urinates less frequently than usual.

Once your baby is eating solid foods, you can offer a few ounces of water between feedings, but don’t force it. Water that is fortified with fluoride will help your baby develop healthy teeth and gums. If you live in an area with nonfluoridated water, your doctor or dentist may prescribe fluoride drops.

Many toddlers become attached to their bottles. Besides providing nourishment, bottles also mean comfort and security.

It’s important for parents to start weaning babies from bottles around the end of the first year and start getting them comfortable drinking from cups. The longer parents wait to start the transition, the more attached kids become to their bottles and the more difficult it can be to break the bottle habit. Longer bottle use may lead to cavities or cause your child to drink more milk than he or she needs.

Switching from bottle to cup can be challenging, but these tips can make the change easier for parents and kids.

Timing the Transition

Most doctors recommend introducing a cup around the time a baby is 6 months old. In the beginning, much of what you serve in a cup will end up on the floor or on your baby. But by 12 months of age, most babies have the coordination and hand skills needed to hold a cup and drink from it.

Age 1 is also when doctors recommend switching from formula to cow’s milk. It can be a natural transition to offer milk in a cup rather than a bottle.

If you’re still breastfeeding, you can continue feeding your baby breast milk, but you may want to do so by offering it in a cup.

Tips to Try

Instead of cutting out bottles all at once, try eliminating them gradually from the feeding schedule, starting at mealtimes.

For example, if your baby usually drinks three bottles each day, start by eliminating the morning bottle. Instead of giving a bottle right away, bring your baby to the table and after the feeding has started, offer milk from a cup. You might need to offer some encouragement and explanation, saying something like “you’re a big boy now and can use a cup like mommy.”

As you try to eliminate the morning bottle, keep offering the afternoon and evening bottles for about a week. That way, if your child asks for the bottle you can provide assurance that one is coming later.

The next week, eliminate another bottle feeding and provide milk in a cup instead. Try to do this when your baby is sitting at the table in a high chair.

Generally, the last bottle to stop should be the nighttime bottle. That bottle tends to be a part of the bedtime routine and is the one that most provides comfort to babies. Instead of the bottle, try offering a cup of milk with your child’s dinner and continue with the rest of your nighttime tasks, like a bath, bedtime story, or teeth brushing.

More Strategies

Here are some other tips to keep in mind:

• Spill-proof cups that have spouts designed just for babies (often referred to as “sippy cups”) can help ease the transition from the bottle. Dentists recommend sippy cups with a hard spout or a straw, rather than ones with soft spouts.
• When your child does use the cup, offer plenty of praise and positive reinforcement. If grandma is around, for example, you might say, “See, Emma is such a big girl she drinks milk in a cup!”
• If you keep getting asked for a bottle, find out what your child really needs or wants and offer that instead. If your child is thirsty or hungry, provide nourishment in a cup or on a plate. If it’s comfort, offer hugs, and if your child is bored, sit down and play!
• As you’re weaning your baby from the bottle, try diluting the milk in the bottle with water. For the first few days, fill half of it with water and half of it with milk. Then gradually add more water until the entire bottle is water. By that time, it’s likely that your child will lose interest and be asking for the yummy milk that comes in a cup!
• Get rid of the bottles or put them out of sight.

If you continue to have problems or concerns about stopping the bottle, talk with your doctor.

At what age can babies switch from breast milk or formula to cow’s milk?
– Tamika

Infants younger than 1 year old need the nutrients in breast milk or formula. Breastfed babies over 1 year may continue to nurse, if desired, but at that point you can begin offering your little one whole milk. Why not low-fat or skim milk? Because most babies need the fat in whole milk to support normal growth and brain development during the busy early toddler period.

You can transition your baby from breast milk or formula to whole milk by beginning to replace bottles of formula with bottles — or sippy cups — of milk. By age 1, your baby should be eating a variety of other foods as well as drinking about 2-3 cups (480-720 milliliters) of milk per day.

If your baby was put on a soy or hypoallergenic formula for a milk allergy, talk to the doctor before introducing milk.