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 more about the benefits of breast-feeding, see the topic Breast-Feeding.

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

Your reasons for wanting to use formula and bottle-feed your baby are personal. You are the only one who can make the best choice for you and your baby. If you are having a hard time breast-feeding and are trying to decide whether to switch to using formula, know that the first few weeks of breast-feeding are the most challenging. You may want to talk to your doctor or join a breast-feeding support group to help you make your choice.

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 until they are 6 months old. (Babies born early or with health problems may drink formula even longer.) After your baby is 4 to 6 months old, you can start to give some solid foods.

What are your choices for infant formula?

There are many types of infant formulas for you to choose from. Most of the time, parents start with formulas made from cow's milk, such as Enfamil, Similac, and Good Start.

Talk to your doctor before you try other types of formulas, including:

• Soy formulas, such as ProSobee and Isomil. These formulas are good for babies who have trouble with cow's milk formulas. They are also used by parents who are vegetarians and don't want to feed their baby animal products.
• Lactose-free formulas, such as LactoFree. These 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.
• Hypoallergenic or protein hydrolysate formulas, such as Nutramigen, Pregestimil, or Alimentum. These are for babies who have trouble with cow's milk and soy formulas.

Formulas for toddlers, such as Enfamil Next Step, are also an option. These formulas have extra nutrients, and you can use them to help your child make the switch to whole milk. But healthy babies and toddlers don't really need them.

When is it okay to start feeding your baby solid food and whole milk?

You can start feeding your baby some solid foods when he or she is about 6 months old but no younger than 4 months old. Bit by bit, give your baby new foods.

After 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, skim 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.

Frequently Asked Questions

What is Expected

Usually your baby can begin bottle-feeding within hours after birth. 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 doctor if you are worried about whether your baby is eating enough.

• On average, your baby should take in about 2.5 fl oz (75 mL) of formula each day for every 1 lb (450 g) of body weight. An 8 lb (3.5 kg) baby drinks about 20 fl oz (600 mL) of formula each day; a 12 lb (5.5 kg) baby drinks about 30 fl oz (900 mL) each day.
• Babies younger than 1 year rarely need more than 36 fl oz (1065 mL) of formula each day.

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 breast-feeding 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 breast-feeding well for at least 6 weeks before offering your baby formula.
• Are there differences between breast- and bottle-fed babies? Infant formulas take two times longer for a baby to digest than breast milk. As a result, formula-fed babies often take fewer feedings, sleep longer at night in the first few months, and have smaller, harder, stronger-smelling stools than breast-fed babies.
• When can I start feeding my baby solid foods? Starting at about 6 months of age (but no earlier than 4 months of age), you can start offering some solid foods to your baby. Gradually introduce new foods as you reduce the amount of formula. For more information, see the topic Weaning.

In an emergency, you can give your baby whole milk for a short time until you can get more formula.

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. Always use an iron-fortified formula unless your doctor advises otherwise. Formulas also come in a ready-to-feed form, which costs the most. If you have questions about which infant formula is right for your baby, talk with your doctor.

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.

Some people are concerned about bisphenol A (BPA), a chemical in some plastic (polycarbonate) bottles. Research hasn't shown that small amounts of BPA harm humans, but researchers are doing more studies. If you don't want to use this type of baby bottle (which may be marked with the number 7 or the letters "PC" near the recycle symbol), you can use glass or BPA-free plastic bottles.

Preparing infant formula

Some things to keep in mind when preparing infant formula:

• Make sure you have clean, safe water to prepare infant formula. Boil water-even bottled water-for 1 to 2 minutes and let it cool before mixing it with formula. You may want to check with your local water supplier about your water's fluoride level.
• Wash your hands before preparing formula.
• 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. Some health professionals recommend boiling bottles and nipples for 5 to 10 minutes after washing them.

Feeding your baby

Always wash your hands before feeding your baby. Fill the bottle with about one more ounce of formula than the amount he or she took during the last feeding.

• Warm the formula to room temperature or body temperature before feeding. It is best to warm it in a pan of heated water, not the microwave. Microwaving formula can cause hot spots in the formula that can burn your baby's mouth. Before feeding 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 should be close to you. It also increases your baby's risk of choking and makes him or her more likely to get ear infections.²

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. When your baby is 6 months old, your doctor may prescribe fluoride drops if your water supply contains less than 0.3 parts per million (ppm) of fluoride. Your local water department or supplier can tell you how much fluoride is in your water supply. 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. Talk with your doctor 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 your baby should continue to get nutrition largely from breast milk or formula until he or she is 12 months old. After that, allowing your child to continue drinking from a bottle may lead to problems such as bottle mouth tooth decay .
• 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. Most doctors suggest daily vitamin D supplements for babies who are breast-fed or who get a mixture of breast milk and formula, starting by age 2 months. Talk with your doctor about how much and what sources of vitamin D are right for your child.³

When to Call a Doctor

Call a health professional 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

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 determine whether he or she is growing at the expected rate.

At each well-baby visit, talk to your doctor about your baby's nutritional needs, which change as he or she grows and develops. For example, babies between 4 and 6 months of age may start eating solid foods.

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 before your visit.

Early and regular dental care is important for your child. Talk with your doctor about how to care for your child's teeth after they start coming in, which is usually between 6 and 12 months of age.⁴ For more information, see the topics Teething and Basic Dental Care.

Other Places To Get Help

Book

Online Resource

Organizations

Related Information

• Basic Dental Care
• Crying, Age 3 and Younger
• Diarrhea, Age 11 and Younger
• Growth and Development, Ages 1 to 12 Months
• Weaning

References

Citations

1. Nix S (2005). Nutrition in infancy, childhood, and adolescence. In Williams' Basic Nutrition Diet Therapy, 12th ed., pp. 192-209. St. Louis: Elsevier Mosby.

2. American Academy of Pediatrics and American Academy of Family Physicians (2004). Clinical practice guideline: Diagnosis and management of acute otitis media. Pediatrics, 113(5): 1451-1465.

3. Wagner CL, et al. (2008). Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. American Academy of Pediatrics Clinical Report. Pediatrics, 122(5): 1142-1152.

4. Hale KJ, et al. (2003). Oral health risk assessment timing and establishment of dental home. Pediatrics, 111(5): 1113-1116.

Other Works Consulted

• American Academy of Pediatrics, Committee on Nutrition (2004). Formula feeding of term infants. In RE Kleinman, ed., Pediatric Nutrition Handbook, 5th ed., chap. 4, pp. 87-97. American Academy of Pediatrics: Elk Grove Village, IL.

• Greer F, et al. (2006). Optimizing bone health and calcium intakes of infants, children, and adolescents. Pediatrics, 117(2): 578-585. Also available online: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;117/2/578.pdf.

• Leleiko NS, Horowitz M (2003). Formulas and nutritional supplements. In CD Rudolph, AM Rudolph, eds., Rudolph's Pediatrics, 21st ed., pp. 1322-1334. New York: McGraw-Hill.

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