Clinical Reference Systems: Pediatric Advisor 10.0
Formula (Bottle) Feeding
BREAST-FEEDING VERSUS FORMULA FEEDING
Breast milk is best for babies, but breast-feeding isn't
always possible. Use an infant formula if:
- You decide not to breast-feed.
- You need to stop breast-feeding and your infant is less
than 1 year old.
- Occasionally you need to supplement breast-feeding with
formula after breast-feeding is well established. Note:
If you want to breast-feed but you think your milk supply
is insufficient, don't stop breast-feeding. Instead seek
help from your physician or a lactation nurse.
Caution: Any bottle feeding, before breast-feeding has been
well established, could reduce your supply of breast milk
and make it difficult to continue breast-feeding.
The decision about the appropriate breast milk substitute
for a child less than 1 year old should be made after
talking with your physician or health care provider. When
you and your physician select a method of infant feeding,
you must consider your lifestyle and the costs of the
different methods of feeding.
TYPES OF FORMULAS AND COW'S MILK
- Commercial formulas
Infant formulas have been designed to meet the
nutritional needs of your infant by providing all known
essential nutrients in their proper amounts. Most
formulas are derived from cow's milk. A few are derived
from soybeans and are for infants who may be allergic to
or have difficulty digesting the type of protein in
Most commercial infant formulas are available in three
forms: powder, concentrated liquid, and ready-to-serve
liquid. Powder and ready-to-serve liquid are the most
suitable forms when formula is used to supplement breast
milk. Powder and concentrated liquid formulas are less
expensive per feeding than ready-to-serve formulas.
The majority of infant formulas contain lactose (milk
sugar) as the only carbohydrate, just as breast milk
does. Lactose aids digestion and promotes normal bowel
function and healthy tissue formation.
A mixture of easily digested fats is also contained in
the formulas. These help protect your baby's skin and
aid the absorption and utilization of certain vitamins.
All known vitamins necessary for the development and
growth of your baby are provided by infant formulas,
including vitamin A for building body cells and good
vision; the B vitamins for maintaining the nervous
system, skin, and tissues; vitamin C for healthy gums
and teeth; vitamin D for strong bones and teeth; and
vitamin E for proper functioning of red blood cells.
Vital minerals such as calcium and phosphorus for
developing bones and teeth, as well as iron for healthy
blood and resistance to infection, are also among the
nutrients supplied in formulas. The American Academy of
Pediatrics recommends that all infants be given a
commercial formula that is iron-fortified. These
formulas do not contain enough iron to cause diarrhea,
constipation, abdominal cramps, or any other symptoms.
With iron-fortified formulas, no supplementary vitamins
or minerals are needed.
- Homemade formulas from evaporated milk
If necessary, you can make your own formula temporarily
from evaporated milk. (Evaporated milk formulas have
some of the same risks as whole cow's milk, namely, iron
deficiency anemia and allergies.) Mix 13 ounces of
evaporated milk with 19 ounces of boiled water and
2 tablespoons of corn syrup. Place this mixture in
sterilized bottles and keep the bottles refrigerated
until use (up to 48 hours).
- Cow's milk
Breast milk is the first choice for feeding during the
first year of life. A commercially prepared infant
formula is the second choice. Whole cow's milk should
not be given to babies before 12 months of age because
of increased risks of iron deficiency anemia and
allergies. Skim or low-fat milk should not be given to
babies before they are 2 years old because the fat in
whole milk is needed for rapid brain growth.
PREPARING COMMERCIAL FORMULAS
Mix concentrated liquid formula with water in a ratio of one
to one. Mix each level scoop of powdered formula with
2 ounces of water. Never make the formula for your baby
more concentrated by adding extra concentrated liquid or
extra powder. Never dilute the formula by adding more water
than specified. Careful measuring and mixing ensure that
your baby receives the proper concentration of formula.
If you use tap water for preparing formula, use only water
from the cold water tap. Let the water run for 2 minutes
before you use it. (Old water pipes may contain lead-based
solder and lead dissolves more in warm water or standing
water.) Fresh, cold water is safe.
If you make one bottle at a time, you don't need to use
boiled water. Just heat cold tap water to the preferred
temperature. Most city water supplies are quite safe. If
you have well water, either boil it for 10 minutes (plus
1 minute for each 1000 feet of elevation above sea level) or
use distilled water until your child is 6 months old.
If you prefer to prepare a batch of formula, you must use
boiled or distilled water and closely follow the directions
printed on the side of the formula can. This prepared
formula should be stored in the refrigerator and must be
used within 48 hours.
In the summertime, many children prefer cold formula. In
the wintertime, most prefer warm formula. By trying formula
at various temperatures you can probably find out what your
child prefers. If you do warm the formula, check the
temperature of the formula before you give it to your baby.
If it is too hot it will burn your baby's mouth. Be
especially careful if you heat the formula in a microwave
because the formula can get too hot very quickly.
FEEDING YOUR BABY
- Schedules and amounts
Your physician will tell you when and how often to feed
your baby. In general, your baby will probably need six
to eight feedings per day for the first 3 weeks, five to
six feedings per day from 1 to 3 months, four to five
feedings per day from 3 to 7 months, and three to four
feedings per day from 7 to 9 months. If your baby is not
hungry at some feedings, increase the time between
Newborns usually start with 1 ounce per feeding, but by
7 days they can take 3 ounces. The amount of formula
that most babies take per feeding (in ounces) can be
calculated by dividing your baby's weight (in pounds) in
half. For example, if your baby weighs 8 pounds, your
baby will probably drink 4 ounces of formula per
feeding. No baby should drink more than 32 ounces of
formula a day. If your baby needs more than 32 ounces
and is not overweight, consider starting solid foods.
Overfeeding can cause vomiting, diarrhea, or excessive
Feeding should be a relaxing time -- a time for you to
provide both food and comfort for your baby.
Make sure that both you and the baby are comfortable:
- Your arm supported by a pillow.
- Baby in a semi-upright feeding position supported in
the crook of your arm. This position reduces choking
and the flow of milk into the middle ear.
- The bottle tilted so that the nipple and the neck of
the bottle are always filled with formula. (This
prevents your baby from taking in too much air.)
- Length of feeding
Gently remove the bottle from time to time to let your
baby rest. A feeding shouldn't take more than
20 minutes. If it does, you are overfeeding your baby
or the nipple is clogged. A clean nipple should drip
about 1 drop per second when the bottle of formula is
- Formula storage
Prepared formula should be stored in the refrigerator
and must be used within 48 hours. Prepared formula left
at room temperature for more than 1 hour should be
thrown away. At the end of each feeding, throw away any
formula left in the bottle.
Burping is optional. It doesn't decrease crying. Its
only benefit is to decrease spitting up. Air in the
stomach does not cause pain. If you burp your baby, be
sure to wait until your baby reaches a natural pause in
the feeding process. Burping two times during feeding
and for about a minute is plenty. More burping may be
needed if your baby is a "spitter."
When you are traveling, powdered or ready-to-serve formulas
are the most convenient. To prepare the formula, simply add
the appropriate number of scoops of powder to bottled,
previously boiled water, or pour ready-to-serve formula into
a sterilized bottle.
Babies do not routinely need extra water. However, when
they have a fever or the weather is hot they should be
offered a bottle of water twice a day. Run the water from
the tap for 2 minutes before you use it for drinking. Keep
some of this water in your refrigerator.
From 6 months to 16 years of age, children need fluoride to
prevent dental caries. If the water supply where you live
contains fluoride and your child drinks at least 1 pint each
day, this should be adequate. Otherwise, fluoride drops or
tablets should be given separately. This is a prescription
item that can be obtained from your child's physician.
PREVENTION OF BABY-BOTTLE TOOTH DECAY
Sleeping with a bottle of milk, juice, or any sweetened
liquid in the mouth can cause severe decay of your baby's
first teeth. Liquids tend to pool in the mouth during
sleep. The sugar in these drinks is changed to acid by
bacteria in the mouth. The acid then etches the tooth
enamel and causes decay.
Prevent this tragedy of tooth decay by not using the bottle
as a daytime or nighttime pacifier. If you cannot
discontinue the nighttime bottle or replace it with a
pacifier, fill it with water. This approach will prevent