Formula feeding

Description
Besides breast milk, commercial infant formula is the most nutritionally complete food for infants. Formula can be used instead of breast milk if breastfeeding is not an option or you choose not to nurse, for supplemental feedings while you're nursing, or after weaning your child from the breast. In fact, for the first year of life, the American Academy of Pediatrics (AAP) recommends breast milk or, when breast milk is not available, an iron-enhanced formula.
Infant formulas are similar to breast milk. The exact composition of breast milk is unknown, however, so formulas are not a perfect match. Formulas come in several forms, including ready-to-use varieties and liquid or powder concentrates. To ensure that each brand of formula contains specific nutritional values, commercial infant formulas are regulated by the U.S. Food and Drug Administration. Each brand has a separate makeup, however. Ask your doctor which formula is best for your baby. There is no evidence that iron-enhanced formulas cause gastrointestinal problems. If you're concerned about allergies, spitting up, bowel movements or other issues, consult your baby's doctor. Remember to check with the doctor before switching formula brands.

If you'd like to nurse your baby and have a chronic illness or breast abnormality, had surgery recently, or are on medication, discuss your wishes with your doctor before delivery. Formula feeding may be recommended in rare situations, such as when an infant has galactosemia (a high level of galactose, a type of sugar in the body) or the mother has HIV (the virus that causes AIDS). Rarely, certain medications or illnesses may prevent you from safely breastfeeding.


Formula feeding instructions
Preparation

Do not give your baby cow's milk. It will not meet your baby's nutritional needs, isn't easily digested, and may strain your baby's kidneys. Also, do not make homemade formula, such as evaporated milk with corn syrup, unless specifically directed by your doctor.

Before feeding your baby, carefully read the instructions on the container's label. Use standard measuring cups and teaspoons to measure unprepared formula.

If you're using concentrated formula, be careful not to make it too weak or strong. Overly diluted formula will not provide your baby with enough nutrients, and he or she may fail to grow or thrive. In some cases, the baby may develop hyponatremia (low salt in the blood), which can lead to seizures. If concentrated formula is weakly diluted or not diluted at all, it may contain too much protein. Formula that's too strong can cause dehydration, high blood sugar, gangrene (tissue death), convulsions (involuntary muscle contractions) or coma. In some cases, formula that's too strong may be fatal.

Before each feeding, wash your hands with soap and water. Then wash the top of the container with soap and water. Use a sharp, clean can opener to open the container.

Ideally, concentrated formula should be mixed with fluoridated water that's free of bacteria and low in nitrates and sodium. Due to potentially contaminated municipal water supplies, the AAP recommends boiling water for one to two minutes and letting it cool before preparing infant formula. A day's supply of formula can be mixed up at one time and refrigerated. If you boil water for the whole day and mix each bottle at feeding time, be sure to refrigerate the water and discard the unused portion of concentrated formula after 24 hours. Consult your baby's doctor if your water has high nitrates -- boiling the water won't solve the problem. (Because infants have low stomach acid, their bodies may change nitrates to nitrites, resulting in an oxygen shortage, rapid breathing and lethargy.)

Concern over bacteria in the water has also prompted some specialists to recommend using only bottles and nipples that have been cleaned in the dishwasher or washed with soap and hot tap water if you have chlorinated water. If you don't have chlorinated water, place bottles and nipples in water that was brought to the boiling point and then removed from the heat source for five minutes after hand washing. (If you wash bottles and nipples by hand, separate them from other dishes. Use hot, soapy water and a bottle brush.)

You can give your baby warm or cold formula. Be consistent, however. Your baby will likely develop a preference. If you heat the formula, avoid using the microwave -- it may not heat the formula evenly and could burn your baby's mouth. Instead, heat the bottle in hot water. Check the temperature of the formula by splashing some onto your wrist. For room temperature formula, leave the bottle out of the fridge for about an hour before feeding.
Feeding

Hold the baby close to you with the baby's head higher than the rest of his or her body. This will help the formula stay down after it's been swallowed.

Tilt the bottle to fill the nipple with formula and touch the nipple to the baby's mouth. The baby should grasp the nipple.

Remember to burp the baby halfway through the bottle or during a break and again after the feeding. Gently pat the baby's back while he or she lies against your shoulder, lies across your lap facing down, or sits up leaning slightly forward with your other hand supporting his or her jaw.

Talk and sing to the baby during each feeding. Make plenty of eye contact. This is a great time to interact and relax with the baby.

Don't prop the bottle in the baby's mouth. The baby may choke. Leaving the bottle in the baby's mouth may also lead to ear infections or tooth decay.
Checking flow of formula

The nipple should be large enough to provide one swallow of milk with each suck. To check the flow, hold the bottle upside down.

The formula should flow in steady drops close together. If the baby seems frustrated and is struggling to suck, the flow is probably too slow. Try enlarging the hole in the nipple with a sterilized needle. You may need to loosen the bottle ring, which can also inhibit formula flow.

If the flow is too fast, the baby may gulp and sputter. Try tightening the bottle ring. If that doesn't work, throw the nipple away.

As the baby sucks, you should hear air entering the bottle and see air bubbles in the formula.

Range of daily intake
Most newborns need to be fed six to eight times a day (every two to four hours). As your baby grows, there will be fewer feedings with more formula in each bottle. From ages 3 to 7 months, your baby may need four or five bottles per day. By ages 7 to 9 months, your baby may need just three or four bottles a day.
Generally, babies take 2 to 3 ounces of formula for each pound of body weight per day. (Ask the baby's doctor for advice if your baby takes much more or less.) For example, a 7-pound baby may take 14 to 21 ounces of formula per day, or 2.5 to 3.5 ounces in each feeding. An 8-pound baby may take 16 to 24 ounces of formula per day, or about 4 ounces per feeding. Ask your baby's doctor when to introduce solid foods.

Babies typically let you know when they're hungry by opening their mouths and leaning forward. (Although feeding on demand is usually recommended, don't feed your baby hourly. Try play or other comfort measures before turning to a bottle.) When they've had enough, they'll often pull away, turn their heads, seal their lips, or push the bottle out of their mouths. Babies tend to eat more during growth spurts and less when they're teething or not feeling well. Let your baby determine how much to eat. Don't force your baby to finish each bottle.

Most healthy infants double their birthweight by age 6 months and triple their birthweight by age 1.


Spitting up
Spitting up can be caused by an immature digestive system, swallowing too much air during feeding, or eating too much. Most babies spit up a small amount at least once in a while. Others spit up after each feeding. Many babies stop spitting up when they learn to sit upright, at about 6 months of age. Some babies spit up until age 1. For babies who are gaining weight and happy, spitting up is usually of no concern.
Here are some tips to help you decrease how often your baby spits up:

Don't feed a crying baby. This will limit the amount of air your baby swallows.
Hold your baby as upright as possible during each feeding.
Burp your baby gently after every couple of ounces, or at least halfway through the feeding.
Make sure the nipple is the right size. Keep the bottle tilted so the nipple fills completely with formula, not air.
Let your baby sit quietly in an upright position (in an infant seat or stroller, for example) after eating. This gives your baby time to digest the food. Right after a feeding, avoid bouncing your baby or passing your baby from person to person.
While your baby sleeps, keep his or her head higher than the stomach by elevating the head of the crib. Also, make sure you place your baby to sleep on his or her back.
Normal episodes of spitting up should not be concerning. Call your baby's doctor if:

Spitting up appears to be affecting your infant's weight gain or growth.
Spitting up causes prolonged gagging or coughing.
The spit up is extremely forceful (projectile vomiting).
The spit up is brown or green.

Storage
Store unopened containers of powder or liquid formula between 45 and 90°F. Cover opened cans of liquid formula and store them in the refrigerator. Throw away:
formula that's left in the bottle after a feeding
a ready-to-feed bottle or mixed powdered formula that's been left at room temperature for more than two hours
ready-to-feed or concentrated formula that's been opened and refrigerated for more than 48 hours
formula that's been prepared and refrigerated more than 24 hours
formula that's been frozen or stored above 95°F
formula that contains streaking or white specks
formula that has expired or is in a damaged container

Considerations
Unless they're prescribed by your baby's doctor, do not give your baby vitamins or iron supplements while using an iron-fortified formula. When you're selecting bottles, keep in mind that formula holds its temperature better in glass bottles. Glass bottles are also easier to clean. Plastic bottles may not maintain their shape, and the animal-shaped variety are hard to clean.

Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
Because good nutrition during pregnancy, infancy and childhood is so important to your child's health, the U.S. Department of Agriculture has established the Special Supplemental Nutrition Program for Women, Infants and Children, otherwise known as WIC. The program provides state funding to help provide supplemental food, health care referrals, and breastfeeding and nutritional education for low-income pregnant and postpartum women and infants and children up to age 5 who are at nutritional risk, often due to certain health problems, pregnancy risks or complications, or an inadequate diet. WIC helps provide foods high in nutrients such as protein, calcium, iron, and vitamins A and C. The program also helps families obtain infant formula and cereals.
WIC is available in every state, the District of Columbia, Indian tribal organizations, Puerto Rico, the Virgin Islands, American Samoa and Guam. The program may vary some from state to state. For details, consult your health care provider or contact your state WIC agency. Information can also be obtained from the U. S. Department of Agriculture.