Health considerations when bottle-feeding

If you decide not to breastfeed, or you are unable to breastfeed, commercial iron-fortified formulas can give your baby the nutrition they need. Infant formulas have the right amounts of protein, calories, fat, vitamins, and minerals for growth. But formula doesn't contain the immune factors that are in breastmilk. The immune factors in breastmilk help prevent infections and other health conditions throughout a baby's life.

Infants who take enough infant formula fortified with iron usually don’t need vitamin and mineral supplements. However, the American Academy of Pediatrics recommends vitamin D supplementation for all babies drinking formula. This is until they are drinking at least 27 ounces a day. Fluoride supplements are recommended for babies whose primary water supply is not fluoridated. Check with your baby's healthcare provider about vitamin D and fluoride supplements.

Types of infant formula

• Cow's milk-based formula. Most infants should be able to tolerate a standard cow's milk formula. Cow's milk formulas are modified to be closer to human milk. These formulas have lactose as the carbohydrate (sugar) source. They are available in ready-to-feed cans, liquid concentrate, and powder. Regular cow's milk is not a correct source of nutrition for a human baby.

• Soy-based or lactose-free formulas. These formulas are used if an infant can’t tolerate lactose. This is rarely a significant problem in babies. They don’t contain lactose as the sugar source. As many as 50% of all infants who are allergic to cow's milk formula will also be allergic to soy-based formulas. Talk with your baby's healthcare provider before changing formulas. Vegetarian parents may prefer soy-based formulas. But they should be aware that breastfeeding is still the best choice.

• Special formulas. There are special formulas for babies who are premature or who have certain rare disorders or diseases. These formulas may have special directions for use. They are prescribed by the baby's healthcare provider.

• Hydrolyzed formulas. Hydrolyzed formulas are easier to digest. They may be used in babies at risk for allergies. They are more expensive than regular formulas. Talk with your baby's healthcare provider before using these formulas.

• Low-iron formulas. These formulas are not recommended.

Helpful hints for feeding your baby

• Breastmilk only is the ideal feeding for at least 6 months. This means no water, sugar water, or formula. Breastfeeding is recommended with the addition of solid foods around six months of age for two years or beyond. This needs to be mutually desired by mother and baby.

• Wait until breastfeeding is well established before giving your baby breastmilk in a bottle.

• Working mothers can use a breast pump on break time and refrigerate or freeze the milk for later use as a bottle-feeding. Refrigerated breastmilk should be used within 4 days after pumping. Frozen breastmilk is good for 6 to 12 months in the freezer. This depends on the type of freezer. Fathers and other family members can be involved in feeding time if breastmilk is offered from a bottle.

• Offer cow's milk-based formula with iron as the first choice of formula if not breastfeeding.

• If you are not breastfeeding, use baby formula until your baby is 1 year old. After this time, you may switch to whole milk. Children under 2 years old should not drink skim or low-fat milk.

• It’s important to follow the formula preparation directions exactly as directed on the packaging. Using too much water can result in poor weight gain. Using too little water can lead to constipation. It's also important to discuss your water supply with your child's healthcare provider. In some areas, water must be boiled first, or bottled water should be used.

• Bottles should never be propped up.

• Babies should never be put to sleep with a bottle. This can cause cavities to develop.

• All babies should be offered a feeding whenever they show signs of hunger. This is true whether babies are breastfed or bottle-fed.