BOTTLE FEEDING

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BRAND and IRON: I generally recommend Similac with iron. Low iron formula is too low in iron and will result in anemia if your baby does not get iron from some other source. There is overwhelming evidence that formula with iron does NOT cause constipation or upset bellies. The iron you took during your pregnancy is several times the dose in formula and the bowel discomfort and constipation associated with this is where the wives tale about iron in formulas started. This wives tale is not true.

HOW OFTEN: I recommend feeding your baby as often as he or she wishes at first. This is usually from every 2 to 4 hours. In a few days, when you and your baby are comfortable feeding, then you can place the baby on an every 3 to 4 hour schedule. Do this by feeding your baby every 3 to 4 hours. When your baby is hungry between meals, give him or her 1/2 to 1 ounce of sterile water. This will tide him or her over from feeding to feeding until he or she gets used to the schedule. I would not let your baby sleep more than 6 hours without a feeding until he or she is a few weeks old. Use sterile water to prepare the formula for the first 4-6 months. Distilled water is sterile water. You may make sterile water by boiling tap water for 5 minutes from the time the water starts boiling and then let the water cool to room temperature. Place the water in the refrigerator and it will keep for 24 hours. You will need to sterilize store bought spring water also, as this is basically tap water. Pedialyte or the sugar water the hospital gave you would be perfectly fine to use, but will get rather expensive and is not necessary. Also do NOT add Kayro syrup, honey or sugar to the formula or breast milk. These will add too many solutes to the liquid or cause an infection and can make your baby quite ill.

HOW TO PREPARE: Similac comes in powder, concentrate and ready to feed. Easy to follow directions are included on every can of formula. Always use sterile water for the first 4 to 6 months and then tap water or boiled well water after that. Prepare only enough for 24 to 36 hours, as the formula is only safe to use within 36 hours if refrigerated. When warming the formula put the bottle in warm or hot water or a commercial bottle warmer. ALWAYS CHECK THE TEMPERATURE OF THE FORMULA BEFORE FEEDING IT TO YOUR BABY. DO NOT USE A MICROWAVE OVEN. Microwave ovens heat unevenly and heat the formula and not the container, therefore the container may be warm while the formula may be above boiling.

HOW MUCH: Your baby needs about 2.3 ounces of formula per pound of body weight per 24 hour period for the first few months. This does not have to be exact as your baby will take a little more or less than this. Simply divide the total amount needed in a day by the number of feedings. For instance, a 9 pound baby needs about 20 to 21 ounces per day (9*2.3) and if fed every 3 hours will need about 2.5 ounces per feeding (21/8). Most babies will be very inconsistent from feeding to feeding. Sometimes they will take 2 ounces and sometimes 4 ounces, but they will be very consistent when you compare amounts taken per day. It is OK if your baby takes more than the amount mentioned above, so long as there are no problems. But if your baby is given more than 3 ounces per pound per day, then he or she may either be colicky from belly pain or spit up more than expected.

BURPING: Try to burp at least 3 to 4 times per feeding. Often babies will tell you they want burped by refusing to take the nipple. If you find your baby gets very gassy, then you need to burp more often, as much as every 1/2 ounce if necessary. If this still does not relieve the gas, then please read the section on gas pain and colic.

BOTTLE POSITION: Try to hold the bottle so that no air is touching the rubber nipple. This will prevent your baby from swallowing too much air and getting gassy. Try not to lay your baby flat and prop the bottle up as this may lead to milk running into the tube connecting the ear with the throat (Eustachian tube) and lead to ear infections. Keep the baby’s head up at least at a 5 to 10 degree incline.

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Copyright 2006, Joe Matusic, MD, FAAP