Formula feeding

If breastfeeding is not an option for you or not your choice, you can feed your baby formula. Infant formula is a healthy alternative to breastmilk and provides babies with the nutrients they need to grow and thrive.

Feedings can be a time of giving more than nutrients to your baby. Here are some suggestions for making this a special time for both you and your baby:

• Use this time to cuddle your baby and hold them close.
• Give your baby the closeness of skin-to-skin contact.
• Look at your baby and talk or sing softly to them.
• Alternate the side you feed your baby on so that they are not always looking in the same direction. This will promote balanced development of their vision and neck muscles.

How to choose formula

Talk with your baby's health care provider about what formula is best for your baby. Although there are many types of formula, most babies do well with one that is cow-milk based.

Unless your baby's health care provider advises against it, choose a formula that is iron-fortified. This is important to prevent iron deficiency, which can slow development.

Once made up, all formula must be refrigerated. Formula should be thrown out after 24 hours if it has not been used.

The different types of formula are:

• powder. This is the least expensive. It does not need to be refrigerated until it is mixed with water. If you are going to be away from home, you may choose a brand that comes in individual packets. This option is more convenient, although more costly.
• concentrated liquid. This needs to have water added to it. It is more expensive than powder. It also must be refrigerated once the container is opened.
• ready-to-use formula. This is the most convenient and the most costly. It can be handy for the times when mixing might be difficult.

How to choose bottles and nipples

You will find many kinds of bottles and nipples at the store. Try several kinds and see what you and your baby like best.

Bottles are made of glass or plastic. When choosing a bottle, consider:

• Glass bottles last longer but may become a problem when a child is old enough to drop or throw one.
• When choosing or reusing plastic bottles:
  • Choose bottles that are made from non-polycarbonate (BPA) plastic.
  • Look for plastics that have the numbers 1, 2 or 5 in the recycling triangle.
  • Look for plastics that are labeled "BPA-free." Studies are suggesting that a potentially harmful chemical (bisphenol A) has been found in clear polycarbonate plastic. This is hard plastic that is usually clear.
• When a plastic bottle becomes cloudy, throw it out. This is a sign that the plastic is beginning to break down.
• Bottles come in two sizes: four ounces and eight ounces. A newborn takes about two ounces at a feeding. You can use the smaller bottles for a while.
• You will need a supply of six to eight bottles. Newborns feed at least eight times in 24 hours.
• You also have the option of buying a "soft bottle" system that uses a disposable bag.

Nipples come in several shapes and sizes. They can be made of silicon or latex. Consider the following:

• Silicon nipples are transparent and easy to keep clean.
• Latex nipples don't collapse easily if your baby sucks hard. You should avoid these, however, if you have a concern about a latex allergy or sensitivity.
• Replace a nipple when it becomes soft, sticky or discolored.
• A nipple should be easy for your baby to suck. If the hole is too big, formula will flow through too quickly. Your baby may have a hard time keeping up with this fast flow. If the hole is too big, don't use the nipple.
• Tightening the plastic ring around the nipple too tightly may slow the flow.
• If a hole gets clogged, you can remove the clog using a sterilized sewing needle.
• It's best to choose nipples and pacifiers that are the same shape.

Bottle and nipple cleaning tips

• If you wash the bottles and nipples by hand, use hot soapy water.
• Use special brushes to get the bottles and nipples clean. Make sure the nipple holes are cleaned well.
• Rinse well with hot water.
• Let the bottles and nipples air dry.
• You can also wash bottles and nipples in a dishwasher. Use a basket to hold the nipples, collars and caps.
• Do not store clean nipples and bottles in an air-tight container. Small amounts of milk could remain on them and cause mold.

How to mix and handle formula

• Check the expiration date on the container. Don't use if the formula is past this date.
• Wash the top of the new container before opening it.
• It is important that you follow the mixing directions on the can. Your baby can get sick if you use too much water or not enough water.
• You may use city water to mix concentrated or powder formula. You may use well water if you boil it before using.
  • Heat the water to a full (rolling) boil for at least one minute.
  • Pour the water into a clean container and cover it. Keep it in the refrigerator.
  • Use the water within three days (72 hours) of mixing formula.
• Most babies prefer to have their formula warmed to body temperature. Some older babies will take a bottle right out of the refrigerator.
• To warm the mixed formula in a bottle, place it in a pan of warm water, or use a bottle warmer.
• Never heat mixed formula in the microwave. This destroys nutrients and can cause hot spots that could burn your baby's mouth or throat.
• Shake the bottle to mix the powder or concentrate evenly.
• Be sure to test the temperature of the formula before giving it to your baby. Squirt a few drops of formula on the inside of your wrist. The temperature should be comfortably warm. It should not be hot.
• Follow the storage instructions on the formula container.
• Throw away mixed formula that has been sitting out at room temperature for more than 30 minutes. It could make your baby sick.

How to formula feed

• After preparing a bottle and testing its temperature, you are ready to give your baby a bottle.
• Feed every two to four hours. Start with one ounce at each feeding. Gradually increase this amount as your baby's appetite grows.
• Make sure your baby's tongue is under the nipple and the baby has more than the tip of the nipple in their mouth.
• Tip the bottle far enough for the formula to fill the nipple and the neck of the bottle.
• Burp your baby after one ounce, or halfway through the feeding for older babies. How often your baby needs to burp depends on how much air was swallowed and how fast your baby drinks. Learn more about burping.
• Expect your baby's appetite to vary from feeding to feeding. Some days your baby may drink a little more formula, other days less.
• Don't try to coax your baby to finish a bottle. Follow your baby's appetite.
• Throw out any formula that remains after a feeding. Don't try to save it for the next feeding.
• Never prop a bottle or leave your baby alone to feed. This is dangerous and can cause choking, ear infections and tooth decay.

How much to formula feed

Here are the amounts of formula your baby needs:

• first day: (¼ ounce) 5 to 15 mL at each feeding
• second day: (½ ounce) 15 to 30 mL at each feeding
• third day: (1 ounce) 30 to 60 mL at each feeding
• fourth day: follow your baby's weight:
  • 8 pounds: 2 ounces (60 mL) at each feeding
  • 9 pounds: 2 ¼ ounces (67 mL) at each feeding
  • 10 pounds: 2 ½ ounces (75 mL) at each feeding

As your baby grows, continue to increase the amount of formula based on their appetite and hunger cues.