BOTTLEFEEDING QUESTIONS

 

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BOTTLE (FORMULA) FEEDING ADVICE (TOPICS 1-19)

  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 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:
    • 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.
    • For preparing a batch of formula, distilled, bottled or boiled water is required.
  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 more than 4 ounces of extra water/day during the first 6 months of life.  (EXCEPTION: don't give any during the first month.)
    • 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 more than 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.
    • The best temperature is the one your infant prefers.
    • 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.
    • Burping is unnecessary.
    • 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:
    • 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 more loose. They are passed day 4 to 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.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Pediatric SelfCareNavigator. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 8/2003

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