Guidelines for Bottlefeeding

H. Darlene Martin
Extension Nutrition Specialist

Nancy M. Lewis
Assistant Professor
Department of Nutritional Science and Dietetics

Copyright/Access Information

A Proper Start in Life. An informed decision about an infant's diet should be based on healthcare professional advice as well as the parents' lifestyles and preferences. Breastfeeding is the preferred method of infant feeding. However, if breastfeeding is not adopted or is discontinued before 12 months of age, iron-fortified infant formula is the best alternative.

Formula comes in many different forms including ready-to-use, liquid concentrate and dry powder. The ready-to-use form needs no added water and is the most expensive. The powder is the least expensive choice. Carefully follow the directions on the container for whatever type you choose. You may want to ask your health care professional to recommend a specific brand and choose a formula with iron unless there are medical reasons why you should not.

If someone else will be feeding your baby, make sure they know exactly how to prepare the formula. Adding water when you don't need it and not adding water when you do can hurt your baby. If you use different forms, make sure you are following the directions on the container.

Appropriate liquids to feed your baby from a bottle are breastmilk, formula or, in hot weather, water. Juices can be fed from a cup after six months of age. Sweetened fruit drinks, carbonated beverages or cereal should not be fed from a bottle. Cow's milk is not appropriate for children under the age of one year, according to the Committee on Nutrition of the American Academy of Pediatrics. At the age of one year whole milk is recommended to the age of two. Babies need the nutrient fat for brain and nerve development. After the age of two you can switch to two percent or lowfat milk.

Equipment Needed for Bottlefeeding

• Nursing bottles with caps. 6 to 8 8-ounce bottles, or fewer if you wash them more than once a day. You may choose reusable bottles or disposable bottles with sterile plastic liners.
• Nipples. One for each bottle with a few spares. Those made of silicone will last longer.
• A bottle brush and a nipple brush.

Once you have chosen and brought home the formula, follow these easy steps to prepare it to feed your baby:

• Always wash your hands with soap and hot water before preparing baby's formula and bottles to prevent infection.
• Use bottles, caps and nipples that have been washed in clean water and dishwashing soap or detergent, or in the dishwasher if you have one. If you wash them by hand, use a bottle brush. Squeeze water through the nipple holes to be sure that they are open. Rinse well to remove all detergent, and let them stand in a rack to dry. (Check the package to see if they should be boiled before you use them the first time.)
• If the formula you've chosen is canned, clean the top of the can with soap and water. Rinse.
• Open the can with a clean punch-type opener.
• Use only fresh water directly from the cold water tap or distilled water if you are mixing a concentrate or powder. If you use cold tap water, let the water run for a short period of time (about two minutes) before collecting water for formula preparation.
• No warming is necessary. Babies can take cold formula, although they may prefer it warm when they are very young. Always test the temperature of the formula before feeding to make sure it is not too hot. Shake the bottle well before testing temperature. Microwave ovens are not recommended for heating infant formulas since there is a danger in overheating the liquid. During the microwaving process, the bottle may remain cool while hot spots develop in the formula. Overheated formula can cause serious burns to the baby.
• Try to feed your baby the formula within 30 minutes after you make it. If it isn't used up within about an hour, throw it away and start again with a clean bottle. Once a baby has nursed from a bottle, microorganisms from the baby's mouth are introduced into the formula. Neither refrigeration nor reheating will prevent microorganisms from growing.
• Keep any opened can of liquid formula covered in the refrigerator (powdered formula does not need to be kept cold until it is mixed with water). An open can of liquid infant formula can be kept for up to 48 hours tightly covered and immediately placed in the refrigerator. Formula prepared from powder should be refrigerated and used within 24 hours. The remaining powder should be tightly covered and stored in a cool, dry place and used within a month after opening.
• Do not freeze infant formula. Although freezing does not affect nutritional quality or sterility, physical separation of the product's components may occur.

If You Use Water from a Well

If you use water from a well instead of a community water supply, have it tested to make sure it is safe before using it for your baby. Boiling well water does not assure safety. The well could contain a high nitrate level which could harm your baby and boiling would concentrate that level. Call your local health department or Cooperative Extension office. They may test it or tell you how to find a company that will do it for you. Use distilled water especially when traveling and you do not know the safety of the water supply.

Bottlefeeding your baby:

• Don't feed formula left at room temperature either in a nursing bottle or open can for more than an hour.
• Don't feed any formula without first reading instructions on the container. Some formulas are sold ready to feed and should not have water added to them. Powdered formulas and concentrated liquid formulas need to be prepared differently.
• Don't give baby vitamins or iron if you are using a prepared infant formula with iron, unless these are specifically prescribed by your doctor and you have told him or her that you are using a formula that contains iron.
• Don't leave a bottle containing formula or anything else with your baby to calm or help him or her sleep. Your baby's teeth are developing and milk, formula, juices or other liquids that remain in your baby's mouth can lead to cavities.
• If you are concerned about your baby's bowel habits or spitting up, don't expect to change them by changing from one brand of formula to another. Ask your health care professional before making changes in formula.

How to bottlefeed:

• Hold your baby close to you in your arms, with the head a little higher than the rest of the body to prevent milk from backing up in the inner ear and causing an ear infection. Never prop a bottle.
• Propping a bottle is psychologically unwise and can be physically dangerous. Holding your baby during feeding is one of the best ways to establish close parent/child bonds.
• Tilt the bottle to be sure that milk is in the nipple. Touch the nipple next to the baby's mouth and the baby will turn and grasp the nipple. Hold the bottle so that it sticks straight out at a right angle to the baby's mouth.
• The nipple's holes should be large enough so that milk drops slowly (about one drop per second) from the bottle when it is held with the nipple down. If your baby is gulping, the formula may be flowing too quickly. Check the nipple holes; they may have enlarged or cracked.
• You should see air bubbles entering the bottle as the baby drinks at a steady rate (except when using plastic-lined bottles that collapse as the bottle empties). If no air bubbles appear, milk has stopped flowing. Check to see that the nipple has clogged or nipple may have collapsed creating a vacuum. Unscrew the cap to release pressure.
• Continue to feed until the baby indicates fullness. Signs of fullness include sealing the lips, absence of a suckle reflex, and spitting out the nipple.
• Burp your baby on your shoulder by patting gently on the baby's back until you hear a burp. (Another way is to hold your baby face down on his or her stomach in your lap over your hand or knee and pat his or her back.) Don't be surprised if the baby brings up some formula along with the swallowed air or if the baby does not burp.
• Alternate arms during feeding. By alternating arms you give your baby an opportunity for additional eye movement.

How often to feed. Feed your baby when he or she seems hungry. Most babies will fall into a pattern of 6 to 8 feedings about 3 to 5 hours apart. It is easier and better to get to a regular schedule by working from the baby's own timing, than by just deciding to feed at certain times whether the baby is hungry or not. You will soon be able to tell from your baby's crying and fussing what his or her needs are.

After a few weeks, most babies will begin to sleep through one of the feedings. Most parents prefer to skip the night feeding rather than a daytime feeding.

How much to feed. Don't worry about how much is taken at a single feeding; most babies will have times when they just aren't hungry and other times when they take more than you expect. If your baby is growing at a satisfactory rate, he or she is probably getting the right amount. Babies should not be hungry after a feeding. Never force a baby to finish what is in the bottle. Babies are the best judge of how much they need.

Most babies, after the first few days, take 2 to 3 ounces of milk each day for each pound of their body weight. Most bottlefed babies want 6 to 8 feedings each day. For a 7-pound baby, this would mean 14 to 21 ounces of formula a day (2 1/2 to 3 1/2 ounces in each 6 or 7 feedings.)

You might begin by offering 3 ounces in each bottle. When your baby begins to empty the bottle completely at 2 or 3 feedings a day, add an additional ounce to the bottle. Stay a little ahead of the baby and let the baby decide how much to take. If your baby begins to empty the bottle completely, add an additional ounce to your next bottle or perhaps prepare an extra bottle with one ounce.

Spitting up. Most babies spit up milk after a feeding. The milk seems to overflow from the baby's mouth. It is often curdled from normal stomach action. This is really not a problem– it is just messy. Before feeding, place a bib or similar article under your baby's chin. Babies who spit up grow as fast and strong as those who do not. There are several tricks to reduce the amount of spitting up. None of them work all the time and most babies will continue some spitting up even when all the tricks are tried. Try to:

• Burp the baby carefully mid-way through the feeding, at the end of the feeding, and a few minutes after the feeding.
• Place the baby's head higher than the stomach for 10 or 15 minutes after each feeding. This can be done by placing the baby in an infant seat or propping up the head of a cradle or bassinet.

Iron-fortified formulas. The American Academy of Pediatrics Committee on Nutrition recommends that iron-fortified formula be used for all formula-fed infants. The feeding of iron-fortified formula to infants has been shown to practically eliminate overt iron deficiency.

Colic. Some babies have attacks of crying nearly every day, most often between 6:00 and 10:00 p.m. During such attacks, they frown, their faces redden, and they draw their legs up. They scream loudly — a cry quite different from the cries of hunger or loneliness. Crying may continue from 2 to 20 minutes or longer. The attack may end suddenly, or soft crying may last a few minutes after the hard crying stops. Just as the baby is about to fall asleep, another attack may occur. Gas may rumble in the stomach and be passed through the rectum. This kind of problem is called “colic.”

No one knows what causes such attacks. They often come at the same time every day. At other times of the day the infant is happy, alert, eats well and gains weight. If your baby has such an attack, holding him or her across your knees on the stomach often will give some comfort. Some colicky babies cry less if they are kept in motion. Try rocking or pushing in a stroller.

There is little you can do except try to comfort the baby until the attack stops. Make sure your baby isn't crying for some other reason (is hungry, wet, lonely, or clothing is uncomfortable). Remember that if your baby has colic, it does not interfere with his or her general health and growth. Your baby should grow out of it by the time he or she is 12 to 16 weeks old.

“Colicky” babies do annoy and distress their mothers and fathers and anybody living in the household. Remind everyone that it is not the baby's fault, it is not your fault, and the baby will get over it. If the colic becomes a real problem, it is worth a special trip to your health care professional.

Resource: DHHS Publication No. HRS-M-CH-89-2
Pediatrics, Vol.84.No.6, December 1989