Infant Formula Feeding

Infant Formula Feeding

Formula Feeding Breast milk has many important advantages for a baby. Commercial formulas provide the next best alternative. If you decide to use infant formula, this handout has information to help you to keep your baby healthy. Plan to use infant formula until your baby is about 9 to 12 months old. Choosing a Formula Infant formulas are sold in three forms: liquid ready-to-use liquid concentrate powdered If your baby is drinking infant formula, you may want to choose liquid formula instead of powdered. Liquid formulas are sterile but powdered formulas are not. Powdered formulas cannot be heated to the temperature needed to kill all bacteria to make them sterile. Always check the expiry date on the formula package. Expired formula may not provide your baby with the nutrients needed to stay healthy. 1

Infant Formula with Iron Iron helps keep your baby s blood healthy. For a healthy, full-term infant, a cow-milk based formula is a suitable choice. Always buy an infant formula with sufficient iron at least 4 mg iron per litre. The nutritional information on the packaging should include this information. If your baby was born premature (before 37 weeks), check with your health care provider to discuss your baby s formula needs. Vitamin/Mineral Supplements If prescribed by your doctor, your baby should receive vitamin and mineral supplements in drop form, placed directly in the mouth. Common Supplement Types Vitamin D Commercial infant formulas contain vitamin D so formula-fed babies do not need an additional supplement. Fluoride For more information about fluoride supplementation, contact your public health office or your dentist. Formulas for Babies who are Sensitive to Cow s Milk For babies who are intolerant of or allergic to cow s milk, your doctor will recommend a specialized formula. Soy-based formulas are for infants who cannot take cow s milk-based formula for medical, cultural or religious reasons. Do not be too quick to switch formulas. Not all upsets are caused by the choice of formula, and in many cases, switching will add to the problem. 2

Home-Prepared, Evaporated Whole Milk Formula Evaporated whole milk (cow s or goat s) is not an infant formula. Evaporated whole milk formula is not as nutritionally complete as breast milk or commerciallyprepared formula; it is missing iron, vitamins and fats that your baby needs. Contact your public health office for more information. Using Whole/Homogenized Milk Whole/homogenized milk can be offered to your baby at 9 to 12 months of age. Note that whole milk has only a trace of iron and iron is needed for babies to be healthy. Before adding whole milk to your baby s diet, be sure he is eating sources of iron from foods such as iron-fortified infant cereal, meat, egg yolks, tofu or legumes. If whole goat s milk is used as an alternative to cow s milk, be sure it is fortified with vitamins A and D. Unpasteurized milk is not safe for babies. Using 2%, 1%, Skim Milk Partly skimmed milks (2%, 1% and skim, either cow s or goat s) are not recommended before 2 years of age. These milks have too little fat for your baby s growth and development. 3

Alternative Beverages Beverages such as soy, rice or other vegetarian choices, whether or not they are fortified, are not suitable alternatives to infant formula or pasteurized whole milk in the first 2 years. If your child requires a soy, rice or other vegetarian beverage after 2 years, contact your public health nurse or doctor for more information. Preparing Formula For the first 4 months, it is important to sterilize your baby s feeding equipment. Sterilizing kills germs that may make your baby ill. How to Sterilize Feeding Equipment You will need a pot big enough to hold all feeding equipment (bottles, nipples, lids, measuring cups, and mixing jugs), and a pair of tongs. Fill the pot with enough water that it will cover all the feeding equipment. The tongs should be placed in the pot to sterilize them with the handles outside the pot. Cover the pot and bring water to a boil. Continue boiling for 2 minutes. Let cool and remove with the sterilized tongs. 4

Mixing the Formula Always make sure to carefully follow mixing instructions on the label of the formula package. If using powdered formula, be sure to use the scoop provided in the package. It is preferable to make one bottle for your baby at a time, and no more than a 24-hour supply should be prepared at once. Liquid concentrate and powdered formulas must be mixed with water that has been boiled to kill bacteria and then cooled. For infants under 4 months of age, water should be brought to a steady boil for at least 2 minutes. The water must be cooled before mixing to prevent vitamin C from being destroyed. Cold tap water, safe well water, commercial bottled water (except carbonated, mineral or distilled water) can be boiled for preparing formula. Water from the hot tap may have high amounts of lead from being in the pipes. If well water is used, it should be tested to ensure it meets current Guidelines for Canadian Drinking Water Quality. Contact your public health office for more information. For infants under 4 months of age, water should be brought to a steady boil for at least 2 minutes. Ready-to-use formula does not need added water. Storing Formula Always read the formula label for instructions. Cans of powdered formula should be kept in a cool dry cupboard and used within one month of opening. Do not freeze formula; manufacturers do not guarantee the quality of their formula if frozen. Do not leave prepared infant formula at room temperature for more than 1 hour. If you re preparing a batch of liquid formula, cover the unused portion and keep it in the refrigerator. Use it within 24 hours. Once your baby has been fed, discard any formula that remains in the bottle. Do not reuse it. 5

Warming Formula Most babies prefer warm formula. To warm the bottle, put it in a pan of hot water for a few minutes. Shake the bottle frequently so it warms evenly. Test the temperature by shaking a few drops on the inside of your wrist. The milk should feel the same as your skin temperature or slightly warm, but not hot. Using the microwave to warm the formula is not recommended. It heats unevenly and can cause hot spots in the formula, which will burn your baby. Many plastics are not recommended for microwave use. If you do choose to warm formula in the microwave, use only microwave-safe containers and heat for a few seconds. Shake the bottle well after heating and check the temperature on the inside of your wrist. Heat again if necessary and re-test temperature. Heat a 250 ml (8 oz) bottle for no more than 45 seconds and a 125 ml (4 oz) bottle for no more than 25 seconds. 6

Feeding your Baby Feed babies when they are wide awake and calm. Your baby will tell you he is ready to eat with clues such as stretching, stirring, putting his fist in his mouth, sucking, smacking lips, searching with an open mouth (rooting), rapid eye movement and waking. Crying is a sign of distress. Make sure you choose a comfortable chair for feeding. Use pillows for extra support. Hold baby so you can look at each other. Hold your baby close, supporting his head, back and bottom. To help prevent choking, hold your baby s head higher than his body. Let your baby feel your warmth, security and love while feeding. Smile and talk to your baby. Cuddle. Offer the bottle by gently touching the nipple on the inside of your baby s lips and against the gums. Be patient. Do not rush or force a feeding. It will cause anxiety for both you and your baby. Hold the bottle so most of the rubber nipple is in the baby s mouth and tilted so the nipple is full of milk. This will prevent the baby from swallowing too much air. Burp the baby about half way through the feeding and again at the end, if needed. Often, changing positions will cause your baby to burp. Alternate the arm you use to hold your baby. This will encourage him to use both eyes and to develop eye contact with you. Signs of fullness include falling asleep, covering their mouth with their hands, turning their head away or crying. Do not encourage finishing a bottle if your baby does not want it. This may encourage overfeeding. Discard the unused portion. Do not add infant cereal to the bottle as this may promote overfeeding. It is unsafe to leave your baby with a propped bottle. This may lead to choking, ear infections, and dental decay. 7

How Much Formula is Enough? Each baby has his own feeding pattern. Feedings are usually small and frequent for newborns and larger and less often as the baby s stomach capacity grows. For example, for the first few days after birth, many babies drink only 15-30 ml (1/2 to 1 oz) at each feeding. Let your baby decide how much formula and how often he wants it. Be flexible. A baby s appetite will change with age, activity and growth. Babies have growth spurts at about 2, 3 and 6 weeks and at 3 and 6 months. They may want extra feedings at these times. Bottle-fed babies are getting enough if they grow steadily and have 6 to 10 soaking wet diapers per day. Stools are generally dark, firm and passed without difficulty. The following chart suggests amounts of formula to offer. Your baby may not drink as much as you offer. Average Amounts of Formula Per Day (1 oz = approximately 30 ml) Number Amount Total of bottles in each amount in Baby s age each day bottle 24 hours birth-2 weeks 6-10 60-90 ml 360-900 ml (2-3 oz) (12-30 oz) 3-8 weeks 6-8 90-120 ml 540-960 ml (3-4 oz) (18-32 oz) 2-3 months 5-6 120-180 ml 600-1080 ml (4-6 oz) (20-36 oz) 4-5 months 5-6 150-180 ml 750-1080 ml (5-6 oz) (25-36 oz) 5-7 months 5-6 150-180 ml 750-1080 ml (5-6 oz) (25-36 oz) 7-9 months 4 180-240 ml 720-960 ml (6-8 oz) (24-32 oz) 9-12 months 3-4 180-240 ml 540-960 ml (6-8 oz) (18-32 oz) Source: Saskatchewan Healthline Babies should have only formula or breast milk until they are 6 months old. Your public health office has information about introducing solid foods. 8

Feb 2014 Developed in collaboration with Public Health Nutritionists of Saskatchewan.