Bottle-Feeding, Formula
DEFINITION
- This guideline covers common questions asked about formula and bottlefeeding
See More Appropriate Topic (instead of this one) If
- Spitting up is main concern, see SPITTING UP
- Breastfed, see BREASTFEEDING QUESTIONS
WHEN TO CALL YOUR DOCTOR
Call 911 Now (your child may need an ambulance) If
- Unresponsive and can't be awakened
- Not moving or very weak
Call Your Doctor Now (night or day) If
- Your child looks or acts very sick
- Age under 1 month old and looks or acts abnormal in any way
- Signs of dehydration (no urine over 8 hours, sunken soft spot and very dry mouth)
- Too weak to suck
- Age under 1 month old and refuses to bottlefeed for over 6 hours
- Refuses to drink anything for over 8 hours
- Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)
- You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
- You think your child needs to be seen, but not urgently
- Doesn't seem to be gaining enough weight
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns
Parent Care at Home If
- Bottlefeeding question about healthy child and you don't think your child needs to be seen
HOME CARE ADVICE FOR BOTTLE (FORMULA)
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.
Switching Formulas and Milk Allergies:
- Switching from one milk-based formula to another milk-based formula is not helpful for any symptom. It is also not harmful.
- 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.
Powdered vs. 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 ounces (60 ml) of water per each level scoop of powder. Never add extra water because dilute formula can cause a seizure.
- 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.
Whole Cow's Milk, 1%, 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 (fat free milk), 1% low fat 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.)
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 child's water supply in most cities.) If prescription needed, discuss with your child's doctor during office hours.
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.
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 (120 ml) 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.
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)
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
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.
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 over 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.
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 your baby's mouth.
Formula Storage: If possible, prepare your child's formula fresh for each feed. However, if formula needs to be made in advance:
- Prepared formula should be stored in refrigerator and must be used within 24 hours
- Open cans of formula should be kept in refrigerator, covered and used within 24 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)
Cereals and Other Solids:
- Bottle-fed infants should be started on solids (cereal or fruit) between 4 and 6 months.
- Starting before 4 months is unnecessary and has the disadvantage of making feedings messier and longer. Early solids can also cause gagging.
- Solids don't increase sleeping through the night for bottle-fed infants.
- Delaying solids past 9 months of age runs the risk that your infant will refuse solids.
Burping:
- It is not harmful if a baby doesn't burp.
- Burping is optional.
- It doesn't decrease crying.
- It can decrease spitting up, but it doesn't reduce crying.
- 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.
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.
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.
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 OK to wash bottles and nipples in the dishwasher.
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.
- Normal 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 usually are yellow in color and peanut butter in consistency. Green stools are also normal (usually caused by bile).
- After 2 months of age, most infants pass 1 or 2 stools per day (or every other day) and they have a soft solid consistency.
Breast Discomfort In Bottle-feeding Mothers: Your breasts will make milk for several days even though you chose not to breastfeed. Breastmilk comes in on day 2 or 3 and swollen breasts can be painful for a few days. Here is what to do:
- Ibuprofen. Take 400 mg of ibuprofen 3 times per day to reduce pain and swelling.There's no special prescription medicine for this.
- Ice. Apply a cold pack or ice bag wrapped in a wet cloth to your breasts for 20 minutes as often as needed. This will reduce milk production. Do not apply heat because it will increase milk production.
- Pumping. For moderate pain, hand express or pump off a little breastmilk to reduce your pain. While pumping breastmilk can increase milk production, doing this to take the edge off your discomfort is not detrimental.
- Bra. Wear a supportive bra (e.g., sports bra) 24 hours a day.
- Binding. Binding the breasts by wearing a tight bra or elastic wrap is no longer recommended. It can increase the risk of breast infections (mastitis).
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.
Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 9/15/2011
Last Revised: 8/1/2011
Content Set: Pediatric HouseCalls Symptom Checker
Copyright 1994-2012 Barton D. Schmitt, M.D.
