Bottle Feeding Your Baby

GENERAL INFORMATION:

What are the choices for feeding my baby?

• You may breast feed.
  
  
• You may choose to pump your breasts with a special pump, and feed breast milk from a bottle. Breast milk may also be saved and frozen to be given at a later time.
  
  
• You may feed your baby formula from a bottle.
  
  
• You may feed your baby both breast milk and formula.

What should I know about bottle feeding formula?

• Bottle feeding makes it easy for you to know how much milk your baby is getting. You can see how much milk your baby is drinking by looking at the bottle markings.
  
  
• Other people can feed your baby, such as the father, friends, grandparents, or daycare provider. Some people feel that bottle feeding gives you freedom and does not tie you down. Older brothers and sisters can get to know the "new baby" by feeding him. Bottle feeding may help you get more rest because others can help with nighttime feedings.
  
  
• Sometimes breast feeding in a public place is difficult. You may bottle feed your baby anywhere.
  
  
• You can use whatever kind of birth control you choose after your baby is born if you feed your baby formula.
  
  
• You do not have to carefully watch your diet if you feed your baby formula.
  
  
• It may be more comfortable having intercourse if you bottle feed formula instead of breast milk. Hormone changes while a woman is producing breast milk may cause painful intercourse, sore nipples, and leaky breasts.

What should I know about bottle feeding breast milk?

• The American Academy of Pediatrics (AAP) encourages breast feeding as the only source of nutrition for your baby over the first 6 months. They do not encourage adding other foods to your baby's diet until your baby is 6 months old. They encourage breast feeding until your baby is at least 1 year old.
  
  
• Breast milk is a natural mixture of protein, fats, carbohydrates (car-boh-HI-drates), vitamins, minerals, and water in the right amounts for your baby. Breast milk also has a special ingredient that may keep your baby from getting sick as often, which formula does not have. Breast milk may also have other natural ingredients that are good for your baby. No baby is allergic to breast milk.
  
  
• Breast milk may be given as soon as it is pumped. If so, it comes premixed and the right temperature for your baby. Formulas need to be mixed, and may need to be heated before feeding them to your baby.
  
  
• Formulas may be expensive to buy, but breast milk does not cost anything.
  
  
• You may find it easiest to breast feed and bottle feed your baby. If you do both, others can help with some feedings. Some babies who breast feed and bottle feed develop "nipple confusion". This is when a baby has trouble switching between the breast and the bottle.
  
  
• Ask your caregiver for more information on expressing, collecting and storing breast milk. If you are a working mother, ask your caregiver for information on using a breast pump to express breast milk.

What should I know about feeding time? Feeding time is a special time for you and your baby to enjoy and get to know each other. It should be a time for you to relax and to show love to your baby. Try to be calm and not hurried. Go to a quiet room and spend time one-to-one with your baby. If you have other children, ask them to have quiet time while you feed your new baby. Turn off the television, computer, and ringer on the telephone. Talk, smile, touch, or sing to your baby while you feed him.

Why should I feed my baby cow's milk formula rather than cow's milk? Cow's milk formula is sold under many different names, and can be found in grocery stores. Regular milk from cows is also sold in grocery stores. Do not give your baby cow's milk for the first 12 months. Babies have trouble digesting (breaking down) regular cow's milk. Formula is made to be easier for babies to digest, and has the right amounts of vitamins and minerals that babies need. Cow's milk has large amounts of certain vitamins and minerals which a baby's kidneys cannot handle. There is also not enough vitamin C in cow's milk to keep your baby's gums and teeth healthy. Cow's milk may also cause your baby to have certain allergies or other problems.

Which formula should I feed my baby?

• Baby formulas will give your baby a balanced diet. Baby formulas have protein, fat, carbohydrates, vitamins, and minerals that your baby needs to grow. How much time and money you have will help you decide which formula to buy. Talk to your caregiver to decide which formula is best for your baby.
  
  
• Check for a date on the formula package. Do not use or buy formula whose date has expired (passed). You should also not use damaged formula containers, or containers without a label on them.

What are the 3 basic kinds of formula?

• Cow's milk formula: Most babies drink cow's milk formula. You can buy it with or without iron, and it is sold under many different names. Some babies do not have enough iron (needed by blood cells) in their bodies. Your baby's caregiver may suggest giving your baby formula with iron until 1 year of age. Formula with iron will cause your baby's BMs to be black. This is normal.
  
  
• Soy formula:
  
  
  • Soy formulas are easier for your baby to digest than cow's milk formula. These formulas have a type of sugar that is easier for a baby to digest. Soy is the protein in soy formula. This protein is not as complete as the protein found in cow's milk formula or breast milk.
    
    
  • You may need to feed your baby soy formula for a while if he has diarrhea (di-uh-REE-uh) (loose stools). You may also need to give your baby soy formula if he is allergic (uh-LER-jik) to cow's milk formula. Your baby may be allergic to both cow's milk formula and soy formula. If so, your baby may need another special type of formula.
    
    
  • Most soy formulas have iron, and cost about the same as cow's milk formula. Your baby may need to be on a soy formula for 1 week to many months right after being born. Caregivers may also ask you to change from regular formula to soy formula if your baby gets sick, or for other reasons. Caregivers will tell you when it is safe for your baby to drink cow's milk formula.
  
  
• Other special formulas: Babies with health problems, such as premature (born early) babies may need to drink special formula. Special formulas cost more money than soy or cow's milk formula. Carefully follow the instructions on special formula packages for mixing and preparing them.

How are formulas supplied? Formula can be bought in the following forms:

• Ready-to-eat formula: This formula can be poured from a can into a baby bottle. It is then ready for your baby to drink. Ready-to-eat formulas are easy to use but cost the most amount of money. Always wash with soap and water, rinse, and dry the tops of formula cans before opening them. Shake formula containers well before opening them. Open the cans with a clean, punch-type opener.
  
  
• Formula that must be mixed with water: This liquid formula does not cost as much as ready-to-eat formula. It is very important that the right amount of water be added to this formula. Carefully follow the instructions on the package to mix the formula correctly. Water from a tap may be not be safe to feed your baby. Ask your caregiver if you should buy or use specially prepared water to mix with the formula.
  
  
• Formula powder:
  
  
  • This formula can be bought in cans or packets, and is mixed with a specific amount of water. Formula powders cost the least amount of money. A measuring scoop comes in each can of formula powder. Use the scoop when measuring the amount of powder to add to water. Formula packets have been measured with a specific amount of formula in them to be added to water. Formula powder is lightweight and can be packed to take places with you and your baby.
    
    
  • It is very important that you follow the package instructions. Always use the correct amount of formula and water. Adding too little water makes the formula too strong. This may cause your baby to be constipated (KON-stih-pa-ted). This means it is hard for your baby to have a BM. If you add too much water to the formula powder, your baby will not gain as much weight, or gain it as fast as he should.
    
    
  • Store formula powder with a tight lid. Do not use it if the date on the container (expiration date) has passed.

Can I make my own formula? Talk to your baby's caregiver before making formula for your baby. Special instructions and supplies are needed to make this formula. Making your baby's formula at home may save money, but it will take time and must be prepared correctly.

• Sterilizing (boiling) formula-making supplies: You do not have to sterilize the supplies used to make formula. Bottles, nipples, and anything else used to make the formula must be very clean. Use your dishwasher or hand wash the bottles and formula-making equipment with hot soapy water.
  
  
• Storing homemade formula: When you are done making the formula, pour it into bottles and store in the refrigerator. Throw away unused formula that has been in the refrigerator for more than 24 hours. Do not freeze homemade formula.

Should I try different formulas? Talk with your caregiver before trying different formulas. If you try different formulas, over time you may learn which formula your baby likes best. You will also learn if a formula upsets your baby's stomach (belly). Some formulas taste better than others to babies. If your baby drinks more of one kind of formula than another, he may like that kind of formula better. Stores may sell formulas made for babies of a certain age group, such as babies over 9 months old. These formulas may be more expensive than the formula that you have been feeding your baby. These formulas are not proven to help your baby grow bigger or develop faster. You do not need to change to a different formula to match the age of your baby during his first year of life.

Do I need to warm the formula or breast milk for my baby?

• Learn how your baby likes formula or breast milk by giving it to him at different temperatures. Most babies enjoy drinking warm formula or breast milk. You may warm it by putting the bottle in a pan of hot water. Running hot water over the bottle is another way of warming the formula or breast milk. Do not warm it in a pot on the stove, because it may curdle.
  
  
• Do not use a microwave oven to heat formula or breast milk. A microwave oven overheats the liquid in the center of the bottle. The liquid may just feel warm when you test it, but it may be very hot in the bottle's center. The breast milk of formula may burn your baby's mouth when he drinks it. The bottle may also explode if you leave it in the microwave oven too long. Always shake the bottle, and then spray the liquid on the inside of your wrist before giving it to your baby. The temperature should be slightly warm and comfortable to your skin. It should not be hot.
  
  
• Your baby may enjoy drinking cold formula or chilled breast milk in hot weather.
  
  
• Always throw away any leftover formula or breast milk. Leftover formula or breast milk that has not been refrigerated can grow germs and make your baby sick. Do not feed your baby breast milk or formula left at room temperature for more than 1 hour. Do not freeze ready-to-eat or premixed formula.

What kind of bottles should I use?

• There are many types of bottles. You may use glass or plastic bottles, or plastic bottles with a plastic liner. Plastic-lined bottles are easy to use and keep your baby from swallowing too much air. This kind of bottle also costs the most money. Do not use glass bottles when your baby is old enough to hold his bottle. The glass bottle may break and cause injury.
  
  
• Bottles come in many sizes. A smaller bottle may be easier to use for babies under 4-6 months old. For babies drinking more than 4 ounces at a time, a larger bottle may be easier to use. Wash bottles well using a bottle brush and hot, soapy water after each use. Some bottles may be washed in a dishwasher.

Are there different kinds of nipples to choose from?

• Talk to your caregiver about what kind of nipple you should use to feed your baby. There are different types and sizes of nipples that may be used in bottle feeding. A breast-shaped nipple may help prevent nipple confusion. A long, soft nipple may be better for newborn babies. Your baby may need a special nipple if he has trouble sucking or swallowing.
  
  
• Always check the size of the hole in the nipple. Turn the bottle upside down and shake it. This will show you if the formula or breast milk is coming through the nipple at the right speed. The flow is OK if you get a little spray of liquid, and then a few drops. The liquid is flowing too quickly if it pours or spurts out. It is flowing too slowly if only a drop or two comes out.
  
  
• Your baby will give you clues about the formula or breast milk flow if you watch him suck. He may choke or gulp if the nipple hole is too large. The flow may be too fast if milk leaks out the corners of your baby's mouth. If the nipple hole is too small your baby may swallow a lot of air from sucking so hard on the nipple. Your baby may be getting his formula or breast milk too slowly if he is sucking very hard, stops sucking, or is fussy.
  
  
• A nipple with 1 large hole or many small holes may be used to feed your baby formula or breast milk. Carefully wash the nipples in hot soapy water and rinse them well after every feeding.

How much formula or breast milk should I give my baby?

• The amount of formula or breast milk your baby drinks may change with each feeding and each day. The amount your baby drinks depends on his weight, how fast he is growing, and how hungry he is. Your baby should take about 2 1/2 ounces of formula or breast milk a day for every pound he weighs. For example, if your baby weighs 10 pounds, he may drink 25 ounces a day. If your baby seems to want to drink more than 32 ounces (1 quart) of liquid a day, talk to your baby's caregiver. If your baby does not want to drink enough liquid, talk to your baby's caregiver.
  
  
• Your baby may want to drink a lot one day and not want to drink much the next. Let your baby tell you when he has had enough to drink. Do not keep feeding your baby after your baby shows signs that he is no longer hungry. He may turn his head away, seal his lips, spit out the nipple, or stop actively sucking. Do not force your baby to empty the liquid from the bottle at each feeding. Your baby may fall asleep near the end of a feeding. If this happens, do not wake him to finish the formula or breast milk.
  
  
• The following information will help you learn how much your baby should drink each day.
  
  
  • First eight weeks: Your baby should drink 6 to 8 times a day during his first eight weeks. He will drink about 2 to 4 ounces at each feeding. He will probably want to drink every 3 to 4 hours. Wake your baby to feed him if he sleeps longer than 4 to 5 hours.
    
    
  • Two to six months: Your baby should drink 4 to 5 feedings each day. He will drink 4 to 8 ounces at each feeding. When your baby is 2-3 months old, he may begin to sleep through the night. When this happens, you may stop waking up to give your baby formula or breast milk in the night. If you are giving your baby breast milk, you may still need to wake up to pump your breasts. You may store the milk for your baby to drink at later time.
    
    
  • Six to 12 months: Your baby should drink 3 to 5 feedings every day. He may drink up to 8 ounces at each feeding. You may increase the time between feedings if your baby is not hungry. You may also start feeding your baby semisolid foods at this age, and add different foods over time. Ask your child's caregiver for more information on the right foods to feed your baby.

How do I hold my baby during feedings?

• You may be comfortable feeding your baby while sitting in a rocking chair or an armchair. Put a pillow under your arm for support. Gently wrap your arm around your baby's upper body, supporting his head with your arm. Be sure your baby's upper body is higher than his lower body. This will help prevent ear infections (in-FECK-shunz).
  
  
• You may need to help your baby open his mouth to grasp the nipple. Do this by stroking the nipple against his cheek near his mouth. To stop your baby from swallowing air, hold the bottle so that liquid fills the bottle neck and covers the nipple.
  
  
• Look into your baby's eyes, talk to, and smile at him during feedings. He will learn to look forward to having your full attention during this special time.
  
  
• Do not prop a bottle in your baby's mouth. Your baby could choke on the nipple, or on the formula or breast milk.
  
  
• Do not let your baby lie down feeding himself with a bottle. Your baby may choke and not have anyone to help him. Your baby is also at a higher risk of getting an ear infection if he is lying flat on his back while drinking. The liquid may flow into his middle ear and cause an infection.
  
  
• Do not let your baby sleep with a bottle. If your baby falls asleep while drinking, liquid will pool around his teeth, and may cause tooth decay and cavities. Teeth with cavities will be painful and may break off.

Do I need to burp my baby?

• Babies tend to swallow air while drinking from a bottle. Air in his stomach makes him feel full before he is really done drinking. It may also make him cry or be fussy. Burp your baby after he drinks every 2 to 3 ounces of formula or breast milk. You should try to burp your baby more often if he seems to be unhappy or is spitting up.
  
  
• If your baby does not burp, feed him more, and gently try to burp him again. Your baby may not burp every time you try to burp him. this is normal. Your baby may also bring up a small amount of breast milk or formula when he burps. It may smell strong and look curdled. This is normal. You may try any of the following positions to burp your baby:
  
  
  • On your shoulder: Put a clean cloth on one of your shoulders to catch spit-up from your baby's burp. Hold your baby against your shoulder. Put one of your hands under your baby's bottom. Gently rub or pat his back with your other hand.
    
    
  • Sitting up: Sit the baby on your lap with his head leaning forward. Support his chest and head with your hand. Gently rub or pat his back with your other hand. Your baby's neck may not be strong enough to hold his head up. Until his neck gets stronger, you must always support his head for him while you hold him. If your baby's head falls backward, he may get a neck injury.
    
    
  • Face down across your lap: Protect your clothes by putting a cloth or towel on your lap. Put your baby face down on your lap. His head should rest on one leg while his stomach rests on the other leg. Gently rub or pat his back with your hand.

How long should each feeding take? Each feeding should take about 20 minutes. Feedings may take longer if your baby has a medical problem, or has trouble sucking or swallowing. A feeding may also take longer if the nipple hole is too small or plugged. Change the arm that you are holding your baby with to the other arm during feedings. This will help you rest your arm, and will give your baby a different view to look at.

Should I have my baby on a certain feeding schedule? Your baby has his own special needs. He will show you when and how much he wants to eat. He may do this by crying or making sounds or movements. You will learn to see and know these signs as you spend time with your baby, and you get to know each other. You may feed your baby on demand, or on a schedule. You may also have your baby on a semi-demand feeding schedule. The following information will help you decide what schedule is best for you and your baby.

• Demand feedings: This is when a baby is given formula or breast milk every time he seems to want to drink. A demand feeding schedule is a schedule that your baby sets based on his hunger. A parent must have breast milk or formula available at all times with this schedule. Your baby may be more satisfied on a demand feeding schedule.
  
  
• Scheduled feedings: This is when a baby is fed at fixed times of the day and night, usually every 3 hours. Scheduled feeding times may meet your needs as a parent because they are planned.
  
  
• Semi-demand feedings: You may want to feed your baby formula or breast milk at certain times of the day. Feeding him before you put him down for a nap or to sleep at night may help him fall asleep easier. The rest of the day you may want your baby to let you know when he is ready to be fed.

Should I feed my baby every time he cries? Babies cry for many reasons, often because they are hungry. You may give your baby too much formula or breast milk if you feed him every time he cries. Your baby may also be crying because he wants to be comforted or held. He may want his diaper changed, or want someone to talk and play with him. If less than 2 hours have passed since your baby was fed, and he drank enough for his age, try to comfort him. Change his diaper, offer him toys, talk or sing to him, and gently rock him before feeding him again.

What are signs that my baby may be allergic to formula?

• Acting fussy.
  
  
• Crying after feeding.
  
  
• Loose, watery BM's, or trouble having BM's. The BM's may be small and very hard.
  
  
• Red rash on your baby's face, or around his rear end. The rash may feel rough when you touch it.
  
  
• Your baby's stomach may feel full or tight after feeding. Your baby may cry and pull his legs up to his belly because he is having belly pain.
  
  
• Vomiting (throwing up) after almost every feeding.
  
  
• Waking up often during the night.

How do I know if my baby is not getting enough formula or breast milk? Call your baby's caregiver if you feel your baby is not drinking enough. The following are signs that your baby may not be getting enough formula or breast milk:

• Not gaining enough weight. Your baby's caregiver will tell you if your baby is not gaining enough weight for his size and age.
  
  
• Not passing very much urine. Your baby should have at least 1 wet diaper every 6 hours.
  
  
• Crying often, with no reason that you can find.
  
  
• Your baby's skin may look loose or wrinkly.
  
  
• Your baby's fontanel (fon-tah-NEL) (soft spot on his head) may look sunk in.
  
  
• Your baby may not move around much, and may seem tired much of the time.

How do I know if my baby is getting too much formula or breast milk? Your baby's caregiver will tell you if your baby is drinking too much. If he is, caregivers may suggest that you decrease the amount of formula you give your baby, and feed him more often. The following are signs that your baby may be getting too much formula or breast milk:

• Gaining too much weight. Your caregiver will tell you if your baby weighs too much.
  
  
• Vomiting (throwing up) most or all of what he was given, right after drinking.
  
  
• Belly pain right after a feeding. Your baby may cry and pull his legs up to his belly because he is having belly pain.

Should I give my baby anything else to drink? Do not give babies under 1 year of age juice, soda or any other drink instead of formula or breast milk. Other drinks are hard for your baby to digest and may harm his kidneys or other organs. Do not give water to a baby less than 1 year old, unless your baby's caregiver tells you to. Your baby is getting all the water he needs from his breast milk or formula. Your baby's caregiver may suggest water for your baby during hot weather, or for a high temperature (fever). Do not force your baby to drink water if he does not want to drink it.

Does my baby need extra vitamins or minerals? Some babies may need vitamin D, iron, fluoride, or other vitamins and minerals. Talk to your baby's caregiver about adding extra vitamins or minerals to your baby's diet.

Call your caregiver if:

• Your baby has a temperature of 100.4 °F (38 °C) or more.
  
  
• You have questions or concerns about your baby's formula or breast milk.
  
  
• Your baby has one or more of the following signs:
  
  
  • A red, rough rash, usually on the face or around the rear end.
    
    
  • Crying for a time after feedings.
    
    
  • Vomiting (throwing up) after nearly every feeding.
    
    
  • A swollen and tight abdomen (belly) after feedings.
    
    
  • Fussy and waking up often during the night.

CARE AGREEMENT:

You have the right to help plan your baby's care. To help with this plan, you must learn about feeding your baby. You can then discuss choices with your baby's caregivers. Work with them to decide what choices may be best for your baby.

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