Formula Feeding

Whether you have decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you are sure to have questions. Here are answers to some common inquiries about formula feeding. 

The major health organizations - including the American Academy of Pediatrics (AAP), American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) - agree that breast milk is the ideal form of nutrition for babies (especially during the first 6 months). However, it's every couple's choice to decide what's best for them and their babies. And commercially prepared formulas are designed and strictly regulated to provide the nutrients your baby needs.

From formula to bottles, from nipples to sterilizers, the choices can seem endless for new parents. But with most of the supplies you will need, it's probably a good idea to hold off buying until you get guidance form your health care provider or the hospital.

The following (adapted from the KidsHealth.gov websites listed at the bottom of this page) are of several of the many questions frequently asked about formula and formula feeding.

What type of formula should I use?

Many different formulas are available which can make the process of choosing one a little overwhelming at first. Of course, which brand you use is up to you, your baby, and your budget.  Infant formula comes in three basic forms:

And within those choices are even more choices. The many kinds of formula on the market include:

All formulas manufactured in the United States have to meet strict nutritional standards from the Food and Drug Administration (FDA), so just because a formula is name brand (versus generic) doesn't necessarily mean that it's the best for your baby.  Whatever kind you choose, make sure to check the expiration date on all cans and bottles of formula, and don't use formula from leaky, dented, or otherwise damaged containers.

My doctor has recommended that I give my baby soy formula. But is it as healthy as cow's milk formula and is it safe?

Most doctors usually recommend giving babies cow's milk formula unless there seems to be an allergy or intolerance, in which case the doctor may recommend soy or hypoallergenic formula. Soy formula - with added iron - contains the nutrients your baby needs; however, some parents may worry after hearing or reading about certain soy concerns, particularly aluminum and phytoestrogens found in soy formulas.

Soy formula should be used under the direction of your child's doctor, but studies have indicated that it is a safe and healthy alternative to cow's milk formula for full-term infants. However, it may not be as beneficial for premature infants. Specific concerns regarding phytoestrogens and aluminum in soy formulas have not been shown to be warranted given that no harmful effects on the growth and nutrition of full-term infants have been found.

I'd like to switch my baby's formula. How can I make the transition from one formula to another?

Before making the decision to switch, be sure to talk to your child's doctor. Parents often assume that formula plays a part in a baby's fussiness, gas, spitting up, or lack of appetite. But often that's not the case.  If your child's doctor says it's OK to switch formulas, he or she will likely recommend a way to do it so that your baby's feedings and digestion aren't interrupted.

Some formulas are advertised as having DHA and ARA. What are they and should my baby's formula have them?

DHA (docosahexaenoic acid) and ARA (arachidonic acid) are new ingredients that weren't used in any infant formulas sold in the United States until 2002. Now they can be found in some, but not all, milk- and soy-based formulas.

DHA and ARA are polyunsaturated fatty acids (consider the "good" kinds of fat) that may be linked to brain and nerve development and can be found naturally in fish oils and eggs. The fatty acids are also found in breast milk. By putting DHA and ARA in infant formulas, the manufacturers are attempting to make their formulas as close to breast milk as possible.  Some studies have indicated that formulas supplemented with DHA and ARA contribute to weight gain and provide benefits to premature infants, although it is not clear whether these formulas are beneficial over the long term.

What kind of bottle should I use?

Many different types of bottles are available. They may be standard reusable (which come in many varieties, such as wide-mouthed and angled) or reusable with disposable sterilized liners or drop-ins (good for quick clean-ups but you'll need a steady supply of new liners). You may need to try a few different brands before you find the combination that works best for you and your baby.

What kind of nipple should I use?

The many different varieties include silicone (clear) or latex (brown), neither of which is better than the other, orthodontic nipples, rounded nipples, wide-based nipples, and flat-top nipples, just to name a few. Nipples also often come in different numbers, "stages," or "flow rates" to reflect the size of the nipple's hole, which affects the flow (i.e., slow, medium, or fast) of formula or breast milk. For example, fast flows may cause babies to gag or may simply give them more than they can handle, whereas slower flows may be frustrating to some babies and may cause them to suck more vigorously and gulp too much air. A nipple's hole is the right size, says the AAP, if you hold the bottle upside down and a few drops come out and then stop.

But whether these different flows are necessary depends on each baby. Your little one may seem to prefer variety, or may be content throughout infancy to use the same kind and size of nipple. If your baby seems fussy or frustrated with the nipple, you can certainly try a different kind or one with a larger - or smaller - hole to see if it makes any difference.

How often will I need to buy new nipples?

That depends on how the nipples you're using hold up to cleaning, sterilizing, and everyday use. Be sure to check nipples regularly for signs of wear and replace them often. Also, as your baby grows, he or she may or may not prefer nipples that come in different sizes and flows (the holes get bigger as babies get older and are ready to handle faster flows).

Is it OK to prop a bottle in my baby's mouth?

No. You shouldn't leave your baby unattended or feeding from a "propped" bottle. This is a choking hazard. Always hold your baby during feedings.

My baby likes to go to sleep with a bottle. Is that OK?

No. You should never put your baby to bed with a bottle. Not only is this a choking hazard, but formula (as well as breast milk or juice) also pools in your baby's mouth, which can lead to baby bottle tooth decay (a serious dental condition) in older babies and toddlers.

Could my baby have an allergy?

Some babies are allergic to the protein in cow's milk formula. Symptoms of an allergic reaction may include vomiting, diarrhea, abdominal pain, rashes, and sometimes even blood in the baby's stools. The following (adapted from the KidsHealth.gov websites listed at the bottom of this page) are of several of the many questions frequently asked about formula and formula feeding.

Do I need to give my formula-fed baby vitamins?

No. Commercial infant formulas are manufactured to contain all the nutrients your baby needs. However, if you're using one that doesn't contain iron, you should talk to your child's doctor about an iron supplement, probably after your little one is 4 months old.

Does my baby need to take fluoride supplements?

The AAP states that infants do not need fluoride supplements during the first 6 months. From 6 months to 3 years, babies require fluoride supplements only if the water supply is severely deficient in fluoride. Well water and bottled water, for example, do not contain fluoride. Ask your health care provider about this and other questions.

Is it normal for my baby to spit up after feedings?

Spitting up is usually perfectly normal.  Sometimes, babies often spit up when they have eaten too much or burp (the notorious "wet burp"),  Many infants will spit up a little after eating or during burping because their digestive tracts are immature. That's perfectly normal. But spitting up isn't the same as vomiting all or most of a feeding.  If you're concerned or your baby is vomiting (that is, forcefully vomiting much of a feeding) more than once a day, call your child's health care provider.  Also, keep in mind that many babies grow out of spitting up by the time they're sitting up.

Things you can do to help alleviate spitting up include:

How can I tell when my baby is hungry?

It's generally recommended that you feed your baby whenever he or she seems hungry, which is called demand feeding (or feeding on demand). But despite what some new parents might think, crying is a late sign of hunger. You should try to feed before your baby gets so hungry that he or she gets really upset and becomes difficult to calm down.

It's also important, however, to realize that every time your baby cries it is not necessarily because of hunger. Sometimes babies just need to be cuddled or changed. Or they could be over stimulated, bored, or too hot or too cold.  One way to tell if your baby is, indeed, ready to eat is to check the clock. If your baby is crying only an hour after a good feeding, there may be something else causing the distress.

How often should I make my baby's bottles?

Some parents opt to make a bottle just before each feeding, but many others choose to pre-make and refrigerate enough to use for the day. If you know your baby eats every 3 or 4 hours, for instance, you can make six to eight bottles to last you all day.

Mix your baby's formula in 2- or 3-ounce (60- or 90-milliliter) servings for the first few weeks and gradually increase the amount as you become familiar with your baby's eating patterns and appetite.

If your baby is staying with a caregiver for a long period of time, you may want to prepare just one or two bottles and leave instructions and supplies (bottles, nipples, formula, and water, if necessary) so the caregiver can prepare bottles as needed and not waste any formula. After all, you'll need to throw away any mixed formula that's been refrigerated after 24 hours.

Is my baby eating enough?

Babies grow at different rates, and at times you may wonder whether your baby is getting enough nutrients to develop properly. Here's a general look at how much your baby may be eating at different stages:

Your newborn's diapers are another good indicator of when your baby is getting plenty to eat. You'll probably be changing at least six wet and four dirty (soiled or "poopy") diapers each day at first. Newborns' stools (or poop) are thick and tarry in the beginning and then become more yellow and seedy as they get older. Wet diapers should have clear or very pale urine. If you see orange crystals in a wet diaper, contact your baby's doctor - these can be a sign of inadequate fluid intake or dehydration.