Williamsville Pediatric Center

Formula Feeding

Like breast milk, formula also

• Provides the proper nutrients at appropriate levels necessary for a baby to sustain a rapid rate of growth and development, and will not stress the infant’s delicate and developing organ systems.
• Because of the special nutritional needs throughout the first year, the baby should be breastfed or receive an iron-fortified formula until at least one year of age, even after the infant is eating solid foods.

Cow’s Milk

The AmericanAcademy of Pediatrics emphatically states that ordinary cow’s milk is not suitable for infants under one year of age. Although nutritious for older children and adults, cow’s milk is not appropriate for infants because:

• Cow’s milk is a poor source of iron. As stated earlier, iron deficiency is the most common nutritional deficiency in infants.
• Cow’s milk that has not been specially heat processed (such as the heat processing used in infant formula) can cause intestinal blood loss in some babies.
• Cow’s milk contains only small amounts of vitamin C, vitamin E, and copper.
• Cow’s milk contains an excessively high level of protein — approximately two to three times higher than either breast milk or infant formula.
• The fat in cow’s milk, different from that present in breast milk and infant formula, is difficult for young babies to digest and absorb.
• The amount of sodium in cow’s milk is greater than the amount an infant should receive.

Soy-Based and Special Formulas

For infants allergic to cow’s milk, milk from goats and other animals or formulas containing large amounts of intact animal protein are inappropriate substitutes for breast milk or cow’s milk-based formulas. If a baby has a family history of allergy or exhibits symptoms of milk (formula) intolerance, the physician may recommend a soy-based formula to help avoid possible allergic reactions. The Academy of Pediatrics states: “In term infants whose nutritional needs are not being met from maternal breast milk or cow-milk based formulas, isolated soy protein-based formulas are safe and effective alternatives to provide appropriate nutrition for normal growth and development.” Note: soy based formula are not nutritionally adequate for the premature baby.

A baby with confirmed allergies will often be given an extensively hydrolysed formula, one in which the protein has been predigested so it will decrease the likelihood of an allergic reaction, or if allergic symptoms persist, a free amino acid-based formula. Both soy, extensively hydrolysed and amino acid-based formulas are nutritionally complete and do not contain whole cow’s milk protein.

Other special formulas are available for infants with special needs. Premature infants, infants unable to digest and absorb nutrients adequately, and infants born with genetic disorders of metabolism (i.e., rare disorders in which the body cannot turn food into energy normally) often require special formulas. Such formulas meet unique nutrient requirements and should only be used under the direction of a physician.

Please speak to your pediatrician with any questions you have regarding special formulas. 

Solid Foods

The AAP recommends waiting until 6 months of age before the introduction of solid foods, and most experts agree that the introduction of solid foods is not necessary before 4 to 6 months of age.   Breast milk or iron-fortified infant formula can provide all of a baby’s nutrient needs in the first 4-6 months of life. Introducing solid foods too early can contribute to overfeeding in some infants, and possibly higher risk of developing allergies (evidence is controversial). Some solid foods (notably those made by pureeing adult table foods) may supply too much sodium and too many calories for the young infant.

A Proper Start In Life

An informed decision regarding an infant’s diet should be based on health professional advice as well as the parents’ lifestyles and preferences. The final decision to breastfeed, formula feed or use a combination of both rests with the parents. Breastfeeding is the preferred method of infant feeding. However, if breastfeeding is
not adopted, is supplemented or is discontinued before 12 months of age, iron-fortified infant formula is the best alternative.

INTERNATIONAL FORMULA COUNCIL
5775 Peachtree-Dunwoody Road • Building G, Suite 500 • Atlanta, GA30342 • (404) 252-3663
Copyright 2004

General Formula Information

1. Preparing Formulas.
   Infant formula should always be prepared and used as directed. Improper use of infant formula could present a health hazard.
   
   To prepare a single bottle of formula, simply add the prescribed amount of powder or concentrated liquid to a single nursing bottle containing previously boiled water. Cap the bottle, shake it for 10 to 15 seconds, and warm the bottle. Test the temperature of the milk by letting a few drops fall on the back of your hand or wrist. It should not be to hot or to cold. You are then ready to feed your baby.
   
   Important note: Always mix all formulas according to instructions on the label or as specifically directed by your physician. Never make the formula more concentrated by adding extra powder or extra concentrated liquid. Never dilute the formula by adding more water then specified. Careful measuring and mixing ensure that your baby is receiving the proper formula.
    
   Refrigerate prepared formula and use it within 24-48 hours.
    
2. Formula Temperature.
   Warming is best done quickly in a pan of warm water.  Microwave heating is not advised because it is difficult to monitor the actual temperature of formula in the center of the bottle. In addition, steam building within the bottle can cause the bottle to explode leading to burns.
    
3. Feeding your baby.
   1. Amounts and Schedules - Your physician will tell you when and how often to feed your baby. In general, your bottle fed baby will probably need 8 to 10 feedings per day for the first 3 weeks, 6 to 8 feedings per day from 1 to 3 months, 4 to 6 feedings per day from 3 to 9 months.
   2. Position - Feeding should be a relaxing time--a time for you to provide both food and comfort for your baby. Make sure that both you and the baby are comfortable:
      
      • Your arm supported by a pillow.
      • Baby is a semi sitting position supported in the crook of your arm.
      • The bottle tilted so that the nipple and the neck of the bottle are always filled with formula. (This prevents your baby from taking in too much air)
   3. Length of feeding - Gently remove the bottle form time to time to let your baby rest. A feeding shouldn't take more than 20 minutes. If it does, you are overfeeding your baby or the nipple is clogged. A clean nipple should drip about 1 drop per second when the bottle of formula is inverted.
   4. Burping - Burping is optional. It may benefit your child by decreasing spitting up. If your burp your baby, burping 2 times during the feeding and for about a minute is plenty.
       
4. Traveling.
   When you are traveling, powdered or ready-to-serve formulas provided the most convenience. To prepare the formula, simply add the appropriate number of scoops of powder and ounces of water to a bottle, or pour ready-to-serve formula into a bottle.
    
5. Extra Water
   Babies do not need extra water.

Adapted from "Your Child's Health", B.D. Schmitt, M.D., Bantam Books.