Bottle Feeding
I am nursing. Should I give my baby a bottle at all?
The use of bottle feeding with the breastfed baby varies with the stage of
breastfeeding and the individual situation. Until breastfeeding is well
established, bottle feedings are not recommended. The change from bottle to
breast can be confusing to the baby, particularly if problems in "latching on"
to the breast nipple or problems of suckling are present. When formula is given,
the infant spends less time stimulating the mother's breast. This can limit the
supply of milk available and hinder the establishment of full lactation.
Once breastfeeding is well established, the use of supplemental bottles is an
individual decision. Many mothers express and freeze breast milk for bottles.
Others prefer to use formula. Bottle feeding may be used occasionally for a
night out or when a mother resumes work.
Should extra water be given to my baby?
Under normal circumstances, breast milk or formula provides the baby with all
the water needed. A daily bottle of water is not needed. When an infant is
exposed to circumstances that increase water losses, such as high environmental
temperatures, the offering of extra water is reasonable. Plain water is fine. If
the breastfeeding baby refuses water, more frequent nursing will normally
prevent dehydration.
Should I feed my baby right away when he cries?
That depends on the circumstances. If your baby begins to cry 3 to 5 hours after
the last feeding, offering formula/milk first may be the logical choice.
However, if the crying occurs before you anticipate the next feeding, check for
other causes. Does the baby need a diaper change? Is he too hot or too cold? Is
he comforted simply by being held? Over the first few weeks with your baby, you
will learn to identify the signals your baby gives you. Through trial and error
you will find out which responses best meet your baby's needs.
My baby is spitting up; should I change formula?
Many normal, healthy babies have episodes of spitting up after feeding. Spitting
up may become a problem if the amounts of formula or breast milk lost are large.
This may cause poor weight gain. If your baby is spitting up large amounts of
formula or breast milk, or has other symptoms in addition to spitting up, call
your baby's physician for further evaluation. Among formula-fed infants, some
will spit up less with one type of formula than another. However, there is no
consistently "better" formula. Changing from one standard formula to another in
a healthy baby can be done with little stress, but, remember, such changes
usually do not cure spitting up.
My baby has lots of gas. Do I need to change my baby's feeding?
All healthy babies produce and pass gas. As long as your baby is having regular
bowel movements and no other problems, no change in feeding is needed. If
additional problems exist, contact your baby's physician for further evaluation.
What is the right number for stool frequency when the baby is nursing?
Stool frequency in breastfed babies is highly variable. Some infants may have a
stool with each feeding; whereas others have one stool every 7 to 8 days. Stool
patterns often change over the first few months of life.
When can I expect my child to stop waking up at night for a feeding?
The number of consecutive hours an infant sleeps at night increases with
age. A majority of babies sleep 6 consecutive hours by 12 weeks of age, and 8
consecutive hours by 20 weeks. However, this does not mean that all babies will
be sleeping through the night by 20 weeks. As many as one-third will still be
having fewer than 6 consecutive hours of sleep at this age.
How do I know when my baby has eaten enough food or formula/milk at a feeding?
Over the first few weeks of life, parents will learn their baby's signals of
fullness. During bottle feeding or breast-feeding, the sucking becomes less
vigorous or stops. When spoon feeding is introduced at 4 to 6 months, the baby
may indicate fullness by refusing to open his mouth or turning the head away.
How do I know if my baby is getting enough food/milk?
Your baby's growth will indicate whether he is getting enough to eat. Your
baby's weight, length, and head circumference are measured at each check-up.
These are plotted on growth curves.
Most babies will establish a growth pattern that falls within a particular
growth channel. A change in this pattern may indicate a feeding or other health
problem. If you are concerned about your baby's growth or diet, ask your
physician to discuss the growth record with you.
How much formula should my baby drink?
The amount of formula/milk that a baby drinks increases gradually over the first
4 to 6 months of life. During the first few weeks, a baby may take as little as
14 to 16 ounces per day. Typically, intakes increase to 30 to 40 ounces over the
first 6 months. Larger babies may actually need more than 40 ounces to maintain
a normal growth pattern. In healthy babies, appetite is the best guide for
determining feeding volume. Over the first few weeks, parents will learn their
baby's signals of hunger and satiety. When these are followed, an appropriate
amount of formula/milk will be given to meet the baby's energy and growth needs.
Parents will find that each baby is an individual. Feeding routines that work
for one baby may not work for another.
What is the minimum amount of formula each day?
There is no clearly defined "minimum" amount of formula/milk. Initially,
newborns may consume as little as 10 to 14 ounces per day and be doing well. The
minimum amount of formula volume for a baby will depend on age, weight, presence
of other foods/beverages in the diet, health, and feeding goals. For growth in a
baby receiving formula and no solids, an intake of at least 2 ounces per pound
of body weight is reasonable. Most healthy, growing babies will drink between 2
to 3 ounces per pound of their body weight.
If your baby is ill and you are worried about providing enough fluid, call your
baby's doctor for guidance. In these circumstances, a different feeding schedule
may be needed. Your baby's needs will also vary depending on the presence of
fever, vomiting, or diarrhea.
What is the maximum amount of formula that can be fed each day?
There is also no clearly defined "maximum" amount of formula/milk. The normal
range of intake for babies is quite broad at all ages. Therefore, a volume of
formula that promotes normal growth in one baby may be too little or too much
for another of the same age.
As babies reach their third month of life, they often begin consuming more than
32 ounces of formula daily. Intakes greater than 40 ounces are needed by some
infants during the third to sixth month of life.
Once solids provide a substantial part of the diet, the "32-ounce-maximum"
guideline is reasonable.
How much formula/milk is necessary for my baby after solid food is introduced?
Initially, when small amounts of solids are given, little or no decrease in
formula/milk volume may occur. As solid foods become a larger part of the diet,
intakes of formula/milk will decrease. By 10 to 12 months of age, most babies
drink 18 to 26 ounces of formula/milk per day.
My 9-month-old baby drinks six 8-ounce bottles of formula each day and refuses
solid foods. Why?
When babies drink large amounts of formula, they do not feel hungry and may
refuse solid foods. To increase the solid food intake, always offer solids
first. Keep the formula out of sight until the feeding of solid foods is
complete.
Should I let my 5-year-old bottle feed the baby?
The answer to this question varies from family to family. Factors to consider
when allowing an older child to feed the baby include
a) Is the older child able to hold the baby in a comfortable feeding position?
b) Does the child hold the bottle in a position to keep milk in the nipple?
c) Does the child know how to respond to how the baby is feeding?
If the answer to each of these questions is yes, it might be possible to have a
child feed the baby; however, adult supervision of feeding is essential. Few
children in kindergarten or the early primary grades can be expected to complete
an entire feeding of a baby. Adult assistance with positioning, identifying
infant responses, and burping should be available throughout the feeding. The
adult should be ready to feed the baby as soon as the 5-year-old's interest
wanes. Often the pause for burping is a good point for ending the older child's
feeding session.
Many parents may feel their older children are not ready for feeding the baby.
An alternative solution is to have the older child bottle feed a doll or other
toy while the baby is being fed by an adult.
How can I wean my baby from the bedtime bottle?
Avoid putting your baby to bed with a bottle. Feed the bedtime feeding in your
arms, and then place the baby in the crib. If you wish to discontinue this
bottle, or are dealing with an established habit of feeding the baby in bed,
substitute a pleasurable experience for this type of feeding. This may be a
quiet period of parent-infant interaction (eg, rocking or a bedtime story). By
avoiding bottles in bed, nursing bottle cavities can also be prevented.
How do I stop breastfeeding?
Gradual discontinuation of breastfeeding results in minimal discomfort to the
nursing mother. This is done by replacing one feeding at a time with a cup or a
bottle, depending on the age of the infant. Since a woman's milk supply is
regulated by the baby's suckling, the volume of milk decreases rapidly to the
lower level of demand. A feeding may be dropped every 3 to 5 days or at longer
intervals if desired.
Sudden cessation of breastfeeding often results in engorgement and discomfort.
Some women may experience fever, chills, and malaise which may last 3 to 4 days.
Is it necessary to sterilize water used for formula preparation? For how long?
Current recommendations for formula preparation are to heat water long enough to
reach a rolling boil. Do not heat water more than one time. These practices
should be continued for the duration of formula feeding or until your baby's
physician indicates it may be stopped.
Is it necessary to sterilize bottles? If so, for how long?
Current recommendations for formula preparation include thorough washing and
sterilizing of all equipment, bottles, and nipples used for formula preparation
and feeding. The recommendations on sterilizing extend for the duration of
formula feeding or until your baby's physician indicates it can be safely
discontinued. Equipment, bottles, and nipples can be sterilized by boiling for
15 minutes.
What happens if the dilution of the formula is not correct?
When formula is prepared according to the instructions on the container, only
very small variations in concentration occur. These should be well tolerated by
the infant. However, problems can arise if the formula is prepared with too much
or too little water. Formula prepared with too much water can lead to water
intoxication. It may also provide too few calories, which limits growth.
Formula prepared with too little water may stress the infant's kidneys or cause
diarrhea. Occasionally, high-calorie formulas are recommended and these are
prepared by using less water. But these formulas should be used only under a
physician's supervision.
Can I use different formulas or do I have to stick to one brand?
There is no rule that you must stay with one brand of formula. Most healthy
babies can tolerate a change from one standard formula to another. Occasionally,
small differences in composition result in one formula being better tolerated by
a baby.
Generally, parents identify one formula that is well tolerated and then continue
its use throughout the period of formula feeding.
Are ready-to-feed and liquid concentrate and powder forms of formula the same?
Which do you recommend?
The ready-to-feed and liquid concentrate and powder forms of a formula are
nutritionally the same. The form chosen depends on the needs of the family.
Ready-to-feed provides the greatest convenience, but is the most expensive.
Liquid concentrates are intermediate in price; the preparation of this formula
is easy and there are fewer mixing errors than with powderpreparation. Powders,
however, have a longer shelf life than liquids, once the can is opened. They are
often used by mothers as a supplement to breastfeeding. Powders are also great
for traveling. Individual feedings can be mixed as needed, reducing the risks
for spoilage.
Is powdered formula as good as the ready-to-feed? Why does it look different
when I make it?
Formula prepared from powder is nutritionally the same as that prepared from
liquid concentrates or ready-to-feed.
Ready-to-feed and liquid concentrates have a creamier color and thicker
consistency than do formulas prepared from powder. These differences are related
to the physical changes that occur during the high-temperature processing of
liquid formulas. This processing is necessary to make a sterile product.
How long can a bottle sit out before it spoils?
Due to variability in temperature and sanitation conditions, a conservative
guideline for use of unrefrigerated formula is suggested. Formula that has not
been offered to the baby should be used within two hours. Formula from a bottle
that has been partially fed should be used within one hour.
How long can I keep formula or breast milk in the refrigerator?
Fresh breast milk may be kept in a refrigerator for up to 48 hours. Breast milk
can be frozen. Frozen breast milk can be transferred to a refrigerator for
thawing. This milk should be used within 24 hours of transfer. Cans of
commercially prepared formulas (ready-to-feed or concentrate) may be safely
stored in the refrigerator for up to 24 hours after opening. Formula that has
been mixed using an aseptic (clean) technique and stored in a refrigerator
should be used within 24 hours of preparation.
How long can I keep breast milk in the freezer?
The length of acceptable storage time for frozen breast milk depends upon the
type of freezer. Breast milk stored in a frost-free freezer should be used
within three months. Breast milk stored in a freezer that is not frost-free may
be kept for up to 6 months. When freezing breast milk, place it in the back or
bottom of a freezer to minimize temperature changes that result from opening the
freezer. Overall, chest freezers provide better storage than upright freezers
since less cold air is lost with opening.
If I use bottled water to prepare formula, do I need a fluoride supplement? How
much?
Some bottled waters are fluoridated. This information will be stated on the
label. If the water you use for formula preparation does not contain fluoride, a
regular supplement is not recommended until after your baby is 6 months old.
After 6 months of age, supplements providing 0.25 mg fluoride per day are
recommended if water contains less than 0.3 ppm of fluoride.
I live in the country. Can I use the water from our private well to make my
baby's formula?
Before using your well water to make formula, have it checked for the presence
of bacteria, nitrates, and fluoride. Your local health department will be able
to tell you where and how to have these tests completed.
Checking for bacteria determines the safety of your well water with respect to
transmission of bacterial diseases.
Nitrates are frequently present in rural wells due to the fertilizers used with
farming. High levels of nitrates in water can cause a condition called
methemoglobinemia in babies. This condition reduces the amount of oxygen carried
by the blood to the baby's body tissues. Boiling of the water does not get rid
of the nitrates; instead, these chemicals become concentrated!
The information on the fluoride content of your well water can be used by your
baby's doctor to determine whether a fluoride supplement is needed after 6
months of age.
Should I microwave the baby's formula/milk in the bottle?
Do not microwave your baby's milk or formula. Microwave ovens frequently heat
milk/formula unevenly. Even though the bottle may feel mildly warm to the touch,
hot spots may be present in the milk formula that can burn your baby's mouth.
Although microwaves seem convenient, the risks outweigh the benefits when it
comes to feeding your baby.
Do bottle or nipple brands really matter?
Currently there is a wide variety of bottles and nipples on the market. No one
combination of equipment is right for every baby.
Some factors you should consider when choosing bottles include:
Durability: How will the bottle withstand sterilizing and handling?
Ease of cleaning: Is it easy to clean? Bottles with extra curves or unusual
shapes are usually more difficult to clean.
If you choose a feeding system that uses presterilized bottle liners, remember
the nipple and nipple ring still need to be sterilized. Follow manufacturer's
guidelines for appropriate sterilization and cleaning procedures.
In choosing nipples, select one that allows the formula to drip slowly from the
hole when turned upside down. Nipples that allow the formula to flow in a steady
stream may provide formula too rapidly and may cause your baby to choke.
Conversely, nipples that allow a slow release of formula may tire some babies
and limit formula intake. Several shapes of nipples are available. Choose one
that your baby accepts well. Although some infants seem to do well with several
different types of nipples, others have a definite preference.
My friend breastfeeds her baby and I am formula feeding my son, they are both
the same age but my friend's baby is taking to solids more quickly, should I be
concerned?
Aside from individual differences in appetite and adventurous spirit between
babies, one major difference that has been observed between breastfed and
formula-fed infants is what you have observed between your friend's baby and
your son: breastfed babies do tend to adapt more easily to new foods and flavors
than formula-fed babies. The explanation for this observation that is finding
more supportive evidence from research in infant taste preferences is that
breast milk carries flavors of the mother's diet, flavors like vanilla or
garlic, for example. A breastfed baby is, therefore, used to his mother's milk
having slightly different flavors depending on what his mother eats. So your
friend's baby has been used to trying new flavors since the day your friend
started breastfeeding him. Your son has probably been on the same formula since
birth and is not used to new flavors in the foods you are feeding him. It's a
matter of familiarity. Your son may take a bit longer to get used to a new food,
but as long as you keep introducing him to a variety of flavor experiences at
his own rate, it's quite likely that he will appreciate as many foods as your
friend's baby over time.
Should I warm infant formula before giving it to my baby?
Infant formula does not necessarily need to be warmed, but most infants prefer
it to be lukewarm or room temperature. To warm refrigerated formula, you can
either leave it out at room temperature for approximately an hour or place it in
a pan of warm water.
If you warm formula, be sure to test it in advance to ensure that it is not too
hot for your baby. Avoid using a microwave to warm formula as microwaves can
cause uneven heating and place infants at risk for burn injuries.
What type of bottles and nipples should I use?
You may use glass or plastic bottles. However, as your child gets older and
begins to hold the bottle by herself, avoid the use of breakable glass bottles.
In general, standard nipples work well for most infants, but if you are
uncertain ask your pediatrician.
Do I need to sterilize water for making formula from powder or concentrate?
Until your child is six months old, boil the water to be used in the formula. As
recommended by pediatricians, bring the water to a boil for one minute, turn it
off and then let it cool either on the stove or in a covered container in the
refrigerator.
Also make sure that all bottles, nipples, and utensils used are clean. Washing
them in hot tap water and detergent should be sufficient.
How should I hold my baby during feeding?
Many women are comfortable sitting in a chair and holding the child in a
semi-upright position with her head supported. To prevent your baby from
swallowing air, hold the bottle at an angle that results in formula fills the
neck of the bottle.
How often should I feed my baby? How do I know that she is getting enough to
eat?
Most newborns will take approximately 2-3 ounces of formula per feeding and will
feed about every 2 to 3 hours during the first weeks of life. For the first
weeks of life, many pediatricians will recommend not letting a baby go more than
3-4 hours without being offered a bottle.
As she ages, let your baby's cues tell you whether she is hungry or not. When
she's hungry, she will root, bring her hands to her mouth and make sucking
motions. When she does, offer a bottle. Feed her as long as she is eager to
drink. Once she starts losing interest, you can burp her and then try again.
Many pediatricians will also recommend that for the first few weeks your child
should sleep no more than 4 - 5 hours without a feeding.
Children who are receiving ample formula will have 7-8 wet diapers per day. By
two months of age most babies will no longer need a middle of the night feeding.
Consult your pediatrician about a feeding schedule.
How should I store formula that I mix in advance?
Formula mixed in advance should be stored in the refrigerator. If you do not use
it within 24 hours then it should be discarded. If not stored in the
refrigerator, the formula must be used or discarded within an hour.
How soon must I use formula after I have placed it in the bottle?
Formula that has not been offered to a baby may sit on a counter for an hour. If
not used by then it should be discarded. Formula remaining in a bottle after a
feeding should be discarded.
How long can I store formula in the refrigerator?
Up to 24 hours. Formula that has been prepared in a clean and proper fashion may
be covered and stored in the refrigerator for 24 hours before being offered to a
baby.
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