Infant Nutrition Part 2: Formula Feeding

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Part One of this blog on infant nutrition addressed breastfeeding. Although there is a consensus, by organizations such as the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), that breastfeeding is the optimal source of nutrition through the first year of your baby’s life, there are times when, through no one’s fault, breastfeeding is simply not an option. Parenting should be as guilt-free as possible and, when needed for whatever reason, infant formulas are a way to also provide excellent nutrition for your baby. We would like to take this opportunity to address the ins and outs of formula feeding as a part of the care for your baby we provide as your Denver pediatrician and medical home.

Choosing an Infant Formula

Reassuringly, an act of Congress governs the content of infant formulas, and the FDA monitors commercial infant formulas to make sure that they meet minimum nutritional and safety requirements. There is no one brand of infant formula that is best for all babies, but the American Academy of Pediatrics (AAP) recommends that iron-fortified formula be used for infants who are not breastfed , or who are only partially breastfed, from birth to twelve months of age. When shopping for an infant formula, make sure that it is not expired and that the container is sealed and in good condition–no leaks, puffy ends or rust spots, please!

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There are several basic types of infant formula to consider when shopping for your newborn:

  • Cow’s Milk Formulas: Cow’s milk formulas account for about 80% of the formulas on the market. Cow’s milk formulas have additional iron added, consistent with the AAP’s recommendation for iron-fortified formula. Don’t worry–the amount of iron in infant formula will not cause constipation in your baby! Most formulas also have certain fatty acids added, which are believed to be important for the development of a baby’s brain and eyes. Some formulas are also fortified with probiotics, which are types of “friendly” bacteria, or prebiotics, which are substances that promote healthy intestinal lining.
  • Hydrolyzed (Hypoallergenic) Formulas: Hydrolyzed formulas are often referred to as being “predigested” because their protein content has been broken down so it can be more easily digested. Your pediatrician may recommend a hydrolyzed (hypoallergenic) formula in an effort to reduce the risk of allergic reactions. According to the AAP, hypoallergenic formulas will help at least 90% of babies who have food allergies, which can cause symptoms such as runny nose, hives and intestinal problems.
  • Soy Formulas: Soy formulas are sometimes recommended for babies who are unable to digest lactose, although lactose-free cow’s milk-based formula is also available. The AAP believes that, for term babies, there are few circumstances where soy formula should be chosen instead of cow milk-based formula. Although some strict vegetarian parents may choose to use soy formula because it contains no animal products, breastfeeding is considered to be the best option for vegetarian families.

Both the FDA and the AAP warn AGAINST using recipes for making homemade infant formula, which may not be safe or meet your baby’s nutritional needs. Homemade formulas may have an increased risk of contamination and may contain too little or too much of certain components, such as vitamins and minerals. You certainly don’t want your baby to get sick or develop an infection!

As your integrative and holistic pediatrician, we are happy to help with any questions you may have regarding the correct infant formula for your baby. No matter what formula you decide to use, the AAP warns AGAINST using illegally imported formula, such as products ordered online from third-party distributors, which may not have been reviewed by the FDA and may not have been shipped and stored properly.

How Much and How Often to Formula Feed

Once you’ve selected a formula, the next question is how much and how often to feed your baby? The answer will depend on the age of your baby:

  • First Few Days: Start by offering your infant 1 to 2 ounces of formula every 2 to 3 hours if your baby is not also receiving breast milk. Feel free to offer your baby more if he or she is showing signs of hunger, such as crying or making suckling motions. Most newborns will feed 8 to 12 times in 24 hours.
  • First Few Weeks: Over the first few weeks, the time between feedings will start to get longer and will run usually about every 3 to 4 hours. If your baby is sleeping longer than 4 to 5 hours and is missing feedings, you should gently wake your baby and offer a bottle.
  • End of the First Month: By the end of the first month, your baby should be up to at least 4 ounces per feeding and should be eating about every 4 hours. The feeding schedule should be becoming fairly predictable by this time.
  • Between Two and Four Months: Sometime during this period, or when your baby weighs more than 12 pounds, most (but not all) babies no longer need a middle of the night feeding (yeah!!) because they are eating more during the day and their sleep patterns have become more regular. They may also go longer between daytime feedings and occasionally up to 4 or 5 hours.
  • By Six Months: At this point, your baby may be consuming 4-8 oz at each feeding plus 2 solid baby food meals a day.  Solid (actually pureed in texture) baby foods offer more calories per ounce than formula, so as solids are added to your baby’s diet, you might actually see the volume of formula per day decrease from what your baby used to drink.
  • Six to Twelve Months: Most babies this age need formula or solid foods about 5 to 6 times in a 24 hour period. As your baby starts to eat more solid foods, the amount of formula needed each day will likely decrease.
  • Twelve Months & OlderAt 12 months, you can gradually switch your now toddler from formula to fortified cow’s milk. A good idea is to start by replacing one formula feeding with fortified cow’s milk as a way to transition. If your baby notes the change in flavor, you may also try adding an ounce of cow’s milk to each bottle, in place of formula, gradually increasing the milk as the days go by.  (Tip: This is also a good time to start offering cups instead of bottles.)

As your Denver pediatrician and medical home in the Mile High City, please contact us if your baby seems to consistently want more or less formula than the above guidelines.

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Formula Preparation and Storage

Formula preparation will depend upon the type of formula you decide to use–ready-to-feed liquid, concentrated liquid or powder. Although the formula container will contain instructions, which should be carefully read and followed, here’s some basic information to keep in mind:

  • Powder Formula: Powder formula preparation is a simple matter of adding powder to premeasured water and shaking–a lot! Always measure the water before adding the powder. Make sure you use water from a safe source and, if you are uncertain, you can use bottled water or bring cold tap water to a rolling boil for 1 minute (no longer) before cooling it to room temperature for no more than 30 minutes before use. Powder formula generally is the most economical choice and works well for most babies.
  • Liquid Concentrate: Preparing liquid concentrate formula is again a matter of adding water and shaking, generally in equal amounts water and concentrate. If you prepare extra formula or have an open container of concentrated formula, it can be covered and stored in the refrigerator for use over the next 48 hours. Liquid concentrate is generally more expensive than powder formula.
  • Ready-To-Feed: Although the most expensive, ready-to-feed formula does not require mixing or measuring, and leaves almost no room for mistakesUnopened cans of this type of formula can be stored at room temperature, and unused portions of opened cans can be covered and refrigerated for up to 48 hours.

No matter what type of formula you choose to use, the AAP warns that extra water should NOT be added to formula. Adding extra water reduces the nutrients the baby receives at each feeding, slowing growth and development, and disturbs electrolyte balances, which can lead to seizures. So, please, always prepare formula according to the manufacturer’s instructions!

Finally, keep in mind that:

  • Unopened infant formula containers should be stored in a cool, dry, indoor place and not in cars, garages or outdoors;
  • Prepared infant formula can spoil if left out at room temperature. Therefore, it should be used within 2 hours of preparation and within one hour of when the feeding begins. If you have not started to use prepared infant formula within 2 hours, store the bottle in the refrigerator and use it within 24 hours;
  • If there is any formula left in a bottle after feeding your baby, throw the left-overs out to avoid bacteria growth;
  • Infant formula does not need to be warmed before feeding. If you do decide to warm a bottle, never use a microwave, which heats unevenly. Instead, place the bottle under running warm water, keeping the water from getting in the bottle or on the nipple. Before feeding, test the temperature by placing a couple of drops of the heated formula on the back of your hand.

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How To Bottle Feed Your Baby

You’ve selected the formula and prepared it according to manufacturer’s instructions-then what? A few tips for feeding your baby from a bottle:

  • Hold your baby close while feeding. The bottle should be positioned at an angle, instead of straight up and down, so that the milk comes out more easily;
  • Allow your baby to take breaks from drinking when he or she seems to want them;
  • Do not prop or leave the bottle in your baby’s mouth, which can increase the risk of choking, ear infections, tooth decay and over-eating;
  • Babies should not be put to bed with a bottle because pooling milk around their teeth can lead to tooth decay; and
  • Don’t force your baby to finish a bottle if she or he appears to be full.

So, regardless of whether breast feeding or infant formula works for you and your baby, you will be providing your child with the excellent nutrition he or she needs to grow and thrive! Hopefully Parts One and Two of this blog have helped you sort through the important issue of infant nutrition, but we are here to assist you in any way we can with any remaining questions you may have or concerns that may arise. We feel privileged to serve as the medical home for your kiddos in the Rocky Mountain region, and we thank you for your trust!

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