Bottle-Feeding

Topic Overview

Is this topic for you?

This topic discusses using a bottle to feed formula to your baby. To learn about using a bottle to feed breast milk to your baby or to learn about breastfeeding, see the topic Breastfeeding.

When is bottle-feeding with formula the best choice for your baby?

If you are having a hard time breastfeeding and are trying to decide whether to switch to using formula, know that the first few weeks of breastfeeding are the most challenging. You may want to talk to your health care provider to help you make your choice. Some moms choose to both breastfeed and bottle-feed their babies.

You may not be able to breastfeed for different health reasons, such as if you've had breast surgery or if you have certain infections. While breast milk is the ideal food for babies, your baby can get good nutrition from formula. Formulas are designed to give babies all the calories and nutrients they need.

What are your choices for infant formula?

There are many types of infant formulas for you to choose from. Almost all infant formulas have some iron in them. If your baby is at risk for low iron, talk to your health care provider about the type of formula your baby needs. Most of the time, parents start with formulas made from cow's milk.

Talk to your health care provider before you try other types of formulas:

• Soy formulas may be recommended for babies who are unable to tolerate cow's-milk formulas or for vegetarian parents who don't want to feed their babies animal products. Or soy formulas may be chosen for cultural, ethical, or religious reasons.
• Soy formula is not recommended for all infants. It should not be given to any infant who has a soy protein allergy.
• Lactose-free formulas are used for babies who are lactose-intolerant, which means that they can't digest lactose, a natural sugar found in foods with cow's milk. Most of the time, lactose intolerance starts in later childhood or adulthood. It is rare in babies.
• Hydrolyzed protein or amino acid formulas are used for babies who cannot tolerate formulas made from cow's milk or soy.
• Do not use homemade formulas, such as those made with evaporated or raw milk. Homemade formulas do not contain the nutrients, vitamins, and minerals your baby needs. They could also make your baby sick.

How do you feed formula to your baby?

When you make formula, use safe water and be sure your hands and equipment are clean. Follow the advice of your health care provider, and read the label on the formula package. Make sure the formula is not too hot or too cold when you give it to your baby.

The length of time between feedings varies. As you get to know your baby, you will be able to notice his or her signs of hunger and fullness. Don't hesitate to call your health care provider if you are worried about whether your baby is eating enough.

After formula is mixed, it needs to be used within 24 hours to be safe. Throw away any formula left in the bottle after you feed your baby, because bacteria can grow in the leftover formula. Reheating or refrigerating won't kill the bacteria.

When is it okay to start giving your baby whole milk?

When your baby is 12 months old, he or she can start to drink whole-fat cow's milk. Other kinds of milk, such as goat's milk, soy milk, fat-free milk, 1% milk, or 2% milk, don't have as many nutrients as whole-fat milk. It is best not to give your baby these kinds of milk if you can give whole-fat milk instead.

What to Expect

Most babies can start bottle-feeding within hours after birth. Most newborns feed about 6 to 10 times every 24 hours. Average feeding amounts will vary depending on your baby's age and how hungry he or she is at that moment.

A baby drinks from a bottle of formula for about 5 to 25 minutes at a time. Pay attention to your baby's nutritional needs and cues. Don't be concerned if your baby doesn't eat much at one feeding. He or she is likely eating enough over the course of a day or two. Forcing your baby to drink more formula than he or she needs can cause tummy aches and spitting up. But don't ever hesitate to call your health care provider if you are worried about whether your baby is eating enough.

Common concerns

You may have the following concerns about bottle-feeding your baby:

• When do I feed my baby? The length of time between feedings varies depending on the amount of formula your baby drank during the previous feeding. Most 2-week-old babies drink about every 2 hours. Older babies often drink more formula at each feeding. They often drink a bottle every 4 hours during the day. Sometimes they go 8 hours or longer between feedings at night. As you get to know your baby, you will be able to recognize his or her signs of hunger and fullness.
• How can I breast- and bottle-feed? You may choose to switch between breastfeeding and formula-feeding. Supplementing breast milk with formula may decrease your supply of breast milk. But it will not stop your breast milk production. It is best to wait until your baby has been breastfeeding well for at least 6 weeks before you offer your baby formula too.
• Which is easier to digest: breast milk or formula? Breast milk is easier to digest. The stool of a breastfed baby is yellow and watery. Formula-fed babies have less-watery stool, and it may be a darker color.
• When can I start feeding my baby solid foods? At about 6 months of age, you can start offering some solid foods to your baby. Some babies may be ready for solid foods at 4 or 5 months. Ask your health care provider when you can start feeding your baby solid foods. Gradually introduce new foods as you reduce the amount of formula. For more information, see the topic Weaning.

Promoting Healthy Growth and Development

Buying formula and supplies

Try to buy your formula and supplies before the baby is born. You can buy infant formula as a liquid concentrate or a powder that you mix with water. Formulas also come in a ready-to-feed form, which costs the most. Always use an iron-fortified formula unless your health care provider advises otherwise. If you have questions about which infant formula is right for your baby, talk with your health care provider.

When you buy baby bottles and nipples, make sure you have a supply of small bottles [about 4 fl oz (120 mL)] for your baby's first few weeks. You may want to buy a variety of different bottle nipples so you can experiment to see which type your baby prefers.

Preparing infant formula

Some things to keep in mind when you prepare infant formula:

• Wash your handsbefore you prepare formula. And make sure the equipment you use, including the mixer and the top of a can of powder, are clean.
• Powder formula may contain some bacteria. Make sure you have clean, safe water to prepare infant formula. If you are not sure if your water is safe, you can use bottled water or you can boil tap water. Boil cold tap water for 1 minute, then cool the water to room temperature. Use the boiled water to mix the formula within 30 minutes. You may want to check with your local water supplier about your water's fluoride level.
• Add the required amount of water to mix the formula. If you add too little water, it can upset your baby's stomach and may harm his or her kidneys. If you add too much water, your baby will not get the nutrition he or she needs.
• Cover the prepared formula and store it in a refrigerator. It should be used within 24 hours.
• Soak dirty baby bottles in water and dish detergent. Wash bottles and nipples in the upper rack of the dishwasher or hand-wash them in hot water with dish detergent. Talk to your health care provider about whether you need to sterilize the equipment you use for formula preparation and feeding.
• In some cases, health care providers recommend adding a thickening agent to a baby's formula. Before you use one, talk to your health care provider about the risks and benefits. If you have any trouble feeding your baby, talk to your health care provider.

Feeding your baby

Always wash your hands before feeding your baby.

• Warm the formula to room temperature or body temperature before feeding. It is best to warm it in a bowl of heated water for 5 to 10 minutes before you feed your baby. Don't use the microwave. Microwaving formula can cause hot spots in the formula that can burn your baby's mouth. Before you feed your baby, check the temperature of the formula by dropping a small amount on the inside part of your wrist. It should be warm, not cold or hot.
• Place a bib or cloth under your baby's chin to help keep his or her clothes clean. Have a second cloth handy to use when burping your baby.
• Hold your baby in a semi-upright position, with your baby's head resting in the crook of your elbow. Keep your baby's head higher than his or her chest.
• Stroke the center of the baby's lower lip to encourage your baby to open his or her mouth wider. With an open mouth, the wider part of the bottle nipple will fit, allowing your baby to make a tight seal between his or her mouth and the bottle nipple. This helps reduce the amount of air the baby sucks in.
• Angle the bottle so that the neck of the bottle and nipple stay full of milk. This helps reduce the amount of air your baby swallows while feeding.
• Do not prop the bottle in your baby's mouth or let him or her hold it alone. These practices deprive your baby of time when he or she could be close to you. This may also increase the risks of choking, tooth decay, and ear infection.

During the first few weeks, burp your baby after every 2 fl oz (60 mL) of formula. This helps get rid of swallowed air, reducing the chances of your baby spitting up. Most babies need less frequent burping as they get older.

You will know your baby is full when he or she stops sucking continuously. Usually, as babies get full, they pause frequently during feeding. Also, your baby may spit out the nipple, turn his or her head away, or fall asleep when full. Throw away any formula left in the bottle after you have fed your baby, because bacteria can grow in the leftover formula.

Feeding is a good time for social contact with your baby, so don't rush. Look into your baby's eyes and talk or sing while you are giving the bottle. This contact helps your baby feel close to you and is important for healthy growth and development. Wear a short-sleeved shirt to give more skin-to-skin contact. Sit in a comfortable chair with your arms supported on pillows.

Other concerns

• How to prevent tooth decay. After your baby's teeth start coming in, it is a good idea to clean them after the last formula feeding at night. Use a soft cloth or gauze pad at first. As more teeth come in, clean them with a soft toothbrush, using only water for the first few months. If you are not sure about the fluoride levels in your drinking water, talk to your health care provider or dentist. Fluoride supplements are sometimes recommended but must be used with caution. Talk with your health care provider about other ways to prevent tooth decay in your young child. For more information, see the topics Teething and Basic Dental Care.
• When to offer liquids from a cup. You can start offering liquids from a cup when your baby is about 6 months old. But make sure your baby continues to get nutrition largely from breast milk or formula until he or she is 12 months old. After that time, try to have your child use a cup instead of a bottle. This can help your child avoid problems such as bottle mouth tooth decay. And to help prevent injuries from using bottles and cups during unsteady walking, have your child stay seated while drinking.
• Whether to give a vitamin D supplement. If you are bottle-feeding formula and your baby drinks at least 32 fl oz (1 L) each day, he or she does not need a vitamin D supplement.^{footnote 1} Most health care providers suggest 400 IU of vitamin D each day from a supplement for babies who are breastfed or who get a mixture of breast milk and formula. Talk with your health care provider about how much and what sources of vitamin D are right for your child.

When to Call Your Health Care Provider

Call your health care provider if your baby:

• Is not growing and gaining weight as expected. About a 2 lb (1 kg) weight gain per month is usually expected for the first few months after birth.
• Is constipated or if his or her stools are hard and/or dry.
• Is vomiting forcefully and seems to be uncomfortable. When vomiting occurs, all or most of a feeding is thrown up.
• Has diarrhea or skin rash or is vomiting or crying inconsolably. Your baby may have developed a cow's milk intolerance or food allergy.
• Has gas, bloating, cramps, and/or diarrhea after drinking milk or eating dairy products. Your baby may have lactose intolerance.
• Has dark areas on his or her teeth or other signs of tooth decay.

Who to see

For routine medical checkups or problems related to your baby's health, the following health professionals can help:

• Pediatrician
• Pediatric nurse practitioner
• Family medicine physician
• Physician assistant
• Registered dietitian

For preventive dental care and problems with your child's teeth, see a dentist. Pediatric dentists specialize in the care and problems of children's teeth.

Routine Checkups

Your baby needs routine medical checkups. During these checkups (called well-baby visits), your baby's height, weight, and head circumference will be measured to find out whether he or she is growing at the expected rate.

At each well-baby visit, talk to your health care provider about your baby's nutritional needs, which change as he or she grows and develops. At about 6 months, most babies can start to eat solid foods. Some babies may be ready for solid foods at 4 or 5 months.

A well-baby visit is a good time to talk about any feeding problems or developmental concerns that you have. You may want to make a list of questions (What is a PDF document?) before your visit.

Early and regular dental care is important for your child. Talk with your health care provider about how to care for your child's teeth after they start coming in, which is usually between 6 and 12 months of age. For more information, see the topics Teething and Basic Dental Care.