Supplementing With Formula

As you are no doubt well aware, health professional organizations these days pretty much universally endorse breastfeeding and extol its many health benefits to mother and child: The American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Nurse-Midwives, American Dietetic Association, American Public Health Association and the World Health Organization all recommend that babies be breastfed for at least 12 months and that for the first six months they be given nothing but breast milk.

But there are circumstances when breastfeeding an infant exclusively is simply not possible (health or milk-supply issues, work demands, adoption, for example). In some cases, you may be able to express your breast milk with a pump; in others, you may need to feed your baby formula, either supplementally or exclusively. Either way, you’ll be reaching for the bottle. Here are a few things to know:

1. All formulas are not the same, though they all try to mimic the proteins, fats, carbohydrates, vitamins, minerals and water in human breast milk. Some are cow’s-milk-based. Some are soy-based. (About 25 percent of formula-fed babies in the U.S. are fed soy-based formula, but the AAP has recently revised its guidelines, concluding, “In term infants, although isolated soy protein-based formulas may be used to provide nutrition for normal growth and development, there are few indications for their use in place of cow milk-based formula. These indications include (a) for infants with galactosemia and hereditary lactase deficiency (rare) and (b) in situations in which a vegetarian diet is preferred.”) Some are hypoallergenic. Some are DHA- or ARA-enriched, and some are not. (The AAP recommends that all formula be iron-fortified.) Some your baby may like and some… not so much. All formulas manufactured in the U.S. must meet strict guidelines established by the Food and Drug Administration. You will of course want to consult with your pediatrician to find out the best choice for you and your baby.
2. If you’re feeding on demand, your baby will generally let you know when he or she is hungry or has had enough. Most babies nurse every two to three hours, though that can vary. As a rule of thumb, babies under six months old usually take about 2 to 2.5 ounces per pound, which means a 10-pound infant will need about 20 to 25 ounces of formula a day, with the amount increasing as your baby grows. If your baby is spitting up a lot or vomiting after feedings or gaining an excessive amount of weight, you’re probably overdoing it and should offer a little less per feeding, compensating with more frequent feedings, if necessary. On the other hand, if your baby is not gaining weight at a normal pace, not peeing frequently enough or persistently crying for feedings, you may need to increase the amount you feed him or her, though you shouldn’t force-feed. Talk to your doctor about finding the right routine.
3. Latex, rubber or silicone nipples? Traditional, orthodontic or flat-topped? And what about the bottles – angled or regular? Glass or plastic – how much should you worry about bisphenol A? You could get overwhelmed with all the choices, or you could just buy a few options and figure out what seems to work for your baby before you stock up. Nipple holes should allow the formula or breast milk to drip out slowly (or at about one drop per second as you hold the bottle upside down); if your baby chokes on a fast flow or seems to be working too hard to suck, you may want to adjust the size of the nipple you’re using. Replace nipples that show signs of wear and make sure you sterilize bottles and nipples before using them by submerging them for 5 minutes in a pot of boiling water. After that, you can just run them through the dishwasher or wash them by hand with hot, soapy water after each use.
4. To warm or not to warm? As it turns out, it’s a matter of preference. There’s no health reason to warm your baby’s formula or pumped breast milk, and, in fact, it can slow things down when your baby is hungry. If you do opt for warming or your baby is fussy about cold or room-temperature milk, warm the bottle by running it under warm (not hot) tap water or in a pan of warm (not boiling) water. Don’t use the microwave: Uneven heating will leave hot and cold pockets and could burn your infant – and it may also affect the nutrients in the breast milk or formula. And be sure to toss any formula left in the bottle after a feeding; saliva germs will multiply quickly in the warmth.
5. Hold your baby when you feed him or her, keeping the head slightly higher than the body to ease swallowing. Burp your baby and switch arms halfway through to give the infant a different view. Never prop the bottle up and leave the baby to feed on its own, which can result in choking and cavities later on. And don’t forget, even if your baby isn’t attached to your breast, this is serious bonding time. Enjoy it.