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 discontinue breast feeding and your infant is less than 1 year of age.
- You need to occasionally supplement your infant after breast feeding is well established. Note: If you want to breast feed but feel your milk supply is insufficient, don’t discontinue breast feeding. Instead seek help from your physician or a lactation nurse.
Infant formulas are a safe alternative to breast milk. They have been designed to resemble breast milk and fulfill 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 the type of protein in cow’s milk. Bottle feeding can provide your child with all the emotional benefits and many of the health benefits of breast feeding. Bottle fed babies grow as rapidly and are as happy as breast fed babies. A special advantage from bottle feeding is that the father can participate. Use a commercial formula that is iron fortified to prevent iron deficiency anemia, as recommended by the American Academy of Pediatrics. The amount of iron in iron-fortified formula is too small to cause any diarrhea or constipation. Don’t use the low-iron formulas.
Most commercial infant formulas are available in three forms: powder, concentrated liquid, and ready- to-serve liquid. Powder and ready-to-serve liquids are the most suitable forms when a formula is occasionally used to supplement breast milk.
Preparing Commercial Formulas
The concentrated formula powders are mixed 1:1 with water. Two ounces of water are mixed with each level scoop of powdered formula. Never make the formula more concentrated by adding extra powder or extra concentrated liquid. Never dilute the formula by adding more water than specified. Careful measuring and mixing ensure that your baby is receiving the proper formula.
If you use tap water for preparing formula, use only water from the cold water tap. If the water hasn’t been used for several hours, 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 one minute for each 1000 feet of elevation) or use distilled water until your child is 6 months of age. 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.
Homemade Formulas From Evaporated Milk
If necessary, you can make your own formula temporarily from evaporated milk. Evaporated milk formulas carry some of the same risks as whole cow’s milk. This formula needs supplements of vitamins and minerals. It also requires sterilized bottles because it is prepared in a batch. If you must use it in a pinch, 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 them refrigerated until used.
Whole Cow’s Milk
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. The ability to drink from a cup doesn’t mean you should switch to cow’s milk. While it used to be acceptable to introduce whole cow’s milk after 6 months of age, studies have shown that infant formula is the best food during the first year of life for babies who are not breast fed. Skim milk or 2% milk should not be given to babies before 2 years of age because the fat content of regular milk (approximately 3.5% butterfat) is needed for rapid brain growth.
When traveling, use powdered formula for convenience. Put the required number of scoops in a bottle, add cold tap water, and shake. A more expensive alternative is to use throwaway bottles of ready-to-use formula. This product avoids problems with contaminated water.
During the summer, many children prefer cold formula. In winter, most prefer warm formula. By trying various temperatures, you can find out which your child prefers. If you do warm the formula, be certain to check the temperature before giving it to your baby. If it is too hot, it could burn your baby’s mouth.
Amounts And Schedules
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. Another way to calculate the ounces per feeding is to add 3 to your baby’s age (in months) with a maximum of 8 ounces per feeding at 5 or 6 months of age. The average amount (ounces) of formula a baby needs in 24 hours is the baby’s weight in pounds multiplied by 2. The maximum amount recommended per day is 32 ounces. Overfeeding can cause vomiting, diarrhea, or excessive weight gain. If your baby needs more than this and is not overweight, consider starting solids.
In general, your baby will need 6-8 feedings per day for the first month, 5-6 feedings per day from 1 to 3 months, 4-5 feedings per day from 3 to 7 months, and 3-4 feedings per day thereafter. If your baby is not hungry at some of the feedings, the feeding interval should be increased.
Length Of Feeding
A feeding shouldn’t take more than 20 minutes. If it does, you are over feeding your baby or the nipple is clogged. A clean nipple should drip about 1 drop per second when the bottle of formula is inverted.
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 discarded. At the end of each feeding, discard any formula left in the bottle, because it is no longer sterile.
Babies do not routinely need extra water. They should be offered a bottle of water twice daily, however, when they have a fever or when the weather is hot and dry.
Burping is optional. It doesn’t decrease crying. Although it may decrease spitting up, air in the stomach does not cause pain. Burping two times during a feeding and for about 1 minute is plenty.
Commercial formulas with iron contain all of the baby’s vitamin and mineral requirements except fluoride. (Note: All soy-based formulas are iron fortified.) In the United States, the most common cause of anemia in children under 2 years old is iron deficiency (largely because iron is not present in cow’s milk). Iron can also be provided at 4 months of age by adding iron-fortified cereals to the diet.
From 6 months to 16 years of age, children need fluoride to prevent dental caries. If the municipal water supply contains fluoride and your child drinks at least 1 pint each day, this should be adequate. Otherwise, fluoride drops or tablets (without vitamins) should be given separately. This is a prescription item that can be obtained from your child’s physician. Added vitamins are unnecessary after your child has reached 1 year of age and is on a regular balanced diet, but continue the fluoride.
Introduce your child to a cup at approximately 4 to 6 months of age. Total weaning to a cup will probably occur somewhere between 9 and 18 months of age, depending on your baby’s individual preference.
Baby-Bottle Tooth Decay: Prevention
Sleeping with a bottle of milk, juice, or any sweetened liquid in the mouth can cause severe decay of the newly erupting teeth. Prevent this tragedy by not using the bottle as a pacifier or allowing your child to take it to bed.