Formula Feeding

Formula Feeding

Bottle feeding like breast feeding has its positive and negative points. Whether you decide to bottle feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, below are answers to some common inquiries about formula feeding.

Formula Feeding

Formula Feeding--Getting Started

The major health organizations agree that breast milk is the ideal form of nutrition for babies, especially during the baby's first 6 months of life. However, it is your choice whether to breast feed or bottle feed your child.  If you are in doubt about what to do, you can always discuss your choices with your health care provider.

Many different formulas are available which can make the process of choosing one a little confusing, but all government approved baby formula is regulated to provide the nutrients your baby needs. Infant formula comes in three basic forms: 1) powders requiring mixing with water; 2) liquid concentrates that require diluting with water; and 3) ready-to-use (or ready-to-feed) liquids that can be poured directly into a baby bottle.  Within these three choices are 4 other choices:

  • cow's-milk-based formulas, the most common type of formula, usually has iron added

  • soy-based formulas are typically used with a baby who may be lactose intolerant or allergic to cow's milk

  • hypoallergenic formulas are for a baby who cannot digest the cow's milk or soy formulas

  • specialized formulas for a low birth-weight baby

All baby formulas manufactured in the United States meet standards set by the Food and Drug Administration (FDA).  Whatever kind you choose check the expiration dates and do not purchase any out of date or damaged products.

The following (adapted from the are of several of the questions frequently asked about formula and formula feeding.

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.

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 baby's health care provider. A parent often assumes that formula plays a part in a baby's fussiness, gas, spitting up, or lack of appetite. But often that is not the case. 

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 were not used in any infant formulas sold in the U. S. 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. 

What kind of bottle should I use?

Many different types of bottles are available. They may be standard reusable (which come as wide-mouthed and angled) or reusable with disposable sterilized liners or drop-ins.

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.  Whether or not your baby needs a nipple with a different level of flow depends on each baby. If your baby seems fussy or frustrated with the nipple, you can try a different kind to see if it makes any difference.

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

No, you should always hold your baby and the bottle during feedings. You should not leave your baby unattended and feeding from a "propped" bottle is a choking hazard.

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) can pool in your baby's mouth and can lead to baby bottle tooth decay.

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.

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

Probably not. Commercial infant formulas are manufactured to contain all the nutrients your baby needs. However, if you are using one that does not contain iron, you should talk to your baby's health care provider about an iron supplement.

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 of age, a baby requires fluoride supplements only if your water supply is deficient in fluoride. Well water and bottled water, for example, do not contain fluoride. Ask your health care provider about this issue.

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

Spitting up is usually normal.  Many infants will spit up a little after eating or during burping because their digestive tracts are immature. But spitting up is different from vomiting all or most of a feeding.  If your baby is regularly vomiting much of each feeding or vomiting more than once a day make sure to call your baby's health care provider.

Things you can do to help alleviate spitting up include:

  • Burp your little one every 3 to 5 minutes during feedings.

  • Don't give your baby a bottle lying down.

  • Keep your baby upright after feedings - putting him or her in an infant seat, stroller, or swing afterward.

  • Don't jiggle, bounce, or actively play with your baby right after feedings.

  • Make sure the nipple hole in your baby's bottle is the right size for your baby. 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.

  • Keep your baby's head above his or her feet while feeding (in other words, don't hold your baby in a dipped-down position when feeding).

  • Raise the head of your baby's crib or bassinet. Roll up a few small hand towels or receiving blankets (or buy special blocks) to place under (not on top of) the mattress. But don't use a pillow under your baby's head.

How can I tell when my baby is hungry?

It is generally recommended that you feed your baby whenever he or she seems hungry, which is called demand feeding.  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 is also important to remember 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 make a bottle just before each feeding but many others choose to pre-make and refrigerate enough to use for the day.  However, it is recommended that you not use any mixed formula that has been refrigerated for more than 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. Below is a general look at how much your baby may be eating at different stages:

  • On average, a newborn consumes about 1.5 to 3 ounces (45 to 90 milliliters) every 2 to 3 hours. This amount increases as your baby grows and is able to take more at each feeding.

  • At about 2 months, your baby may be taking 4 to 5 ounces (120 to 150 milliliters) at each feeding and the feedings may be every 3 to 4 hours.

  • At 4 months, your baby may be taking 4 to 6 ounces (120 to 180 milliliters), depending on the frequency of feedings and his or her size.

  • By 6 months, your baby's formula intake can be between 24 to 32 ounces (720 to 950 milliliters). This also depends on whether you've introduced any baby food.

Your newborn's diapers are another good indicator of when your baby is getting plenty to eat. You typically will be changing at least 6 wet and 4 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 health care provider since this can be a sign of inadequate fluid intake.

Additional Information

Formula feeding:-getting started

Formula feeding: how much, how often?

Kids health: Formula feeding: -some common concerns


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