Bottle-Feeding

Promoting Healthy Growth and Development

Buying formula and supplies

Try to buy your formula and supplies before the baby is born. You can buy infant formula as a liquid concentrate or a powder that you mix with water. Always use an iron-fortified formula unless your doctor advises otherwise. Formulas also come in a ready-to-feed form, which costs the most. If you have questions about which infant formula is right for your baby, talk with your doctor.

When you buy baby bottles and nipples, make sure you have a supply of small bottles [about 4 fl oz (120 mL)] for your baby's first few weeks. You may want to buy a variety of different bottle nipples so you can experiment to see which type your baby prefers.

Some people are concerned about bisphenol A (BPA), a chemical in some plastic (polycarbonate) bottles. Research hasn't shown that small amounts of BPA harm humans, but researchers are doing more studies. If you don't want to use this type of baby bottle (which may be marked with the number 7 or the letters "PC" near the recycle symbol), you can use glass or BPA-free plastic bottles.

Preparing infant formula

Some things to keep in mind when preparing infant formula:

• Make sure you have clean, safe water to prepare infant formula. Boil water—even bottled water—for 1 to 2 minutes and let it cool before mixing it with formula. You may want to check with your local water supplier about your water's fluoride level.
• Wash your hands before preparing formula.
• Add the required amount of water to mix the formula. If you add too little water, it can upset your baby's stomach and may harm his or her kidneys. If you add too much water, your baby will not get the nutrition he or she needs.
• Cover the prepared formula and store it in a refrigerator. It should be used within 24 hours.
• Soak dirty baby bottles in water and dish detergent. Wash bottles and nipples in the upper rack of the dishwasher or hand-wash them in hot water with dish detergent. Some health professionals recommend boiling bottles and nipples for 5 to 10 minutes after washing them.

Feeding your baby

Always wash your hands before feeding your baby. Fill the bottle with about one more ounce of formula than the amount he or she took during the last feeding.

• Warm the formula to room temperature or body temperature before feeding. It is best to warm it in a pan of heated water, not the microwave. Microwaving formula can cause hot spots in the formula that can burn your baby's mouth. Before feeding your baby, check the temperature of the formula by dropping a small amount on the inside part of your wrist. It should be warm, not cold or hot.
• Place a bib or cloth under your baby's chin to help keep his or her clothes clean. Have a second cloth handy to use when burping your baby.
• Hold your baby in a semi-upright position, with your baby's head resting in the crook of your elbow. Keep your baby's head higher than his or her chest.
• Stroke the center of the baby's lower lip to encourage your baby to open his or her mouth wider. With an open mouth, the wider part of the bottle nipple will fit, allowing your baby to make a tight seal between his or her mouth and the bottle nipple. This helps reduce the amount of air the baby sucks in.
• Angle the bottle so that the neck of the bottle and nipple stay full of milk. This helps reduce the amount of air your baby swallows while feeding.
• Do not prop the bottle in your baby's mouth or let him or her hold it alone. These practices deprive your baby of time when he or she should be close to you. It also increases your baby's risk of choking and makes him or her more likely to get ear infections.²

During the first few weeks, burp your baby after every 2 fl oz (60 mL) of formula. This helps get rid of swallowed air, reducing the chances of your baby spitting up. Most babies need less frequent burping as they get older.

You will know your baby is full when he or she stops sucking continuously. Usually, as babies get full, they pause frequently during feeding. Also, your baby may spit out the nipple, turn his or her head away, or fall asleep when full. Throw away any formula left in the bottle after you have fed your baby because bacteria can grow in the leftover formula.

Feeding is a good time for social contact with your baby, so don't rush. Look into your baby's eyes and talk or sing while you are giving the bottle. This contact helps your baby feel close to you and is important for healthy growth and development. Wear a short-sleeved shirt to give more skin-to-skin contact. Sit in a comfortable chair with your arms supported on pillows.

Other concerns

• How to prevent tooth decay. When your baby is 6 months old, your doctor may prescribe fluoride drops if your water supply contains less than 0.3 parts per million (ppm) of fluoride. Your local water department or supplier can tell you how much fluoride is in your water supply. After your baby's teeth start coming in, it is a good idea to clean them after the last formula feeding at night. Use a soft cloth or gauze pad at first. As more teeth come in, clean them with a soft toothbrush, using only water for the first few months. Talk with your doctor about other ways to prevent tooth decay in your young child. For more information, see the topics Teething and Basic Dental Care.
• When to offer liquids from a cup. You can start offering liquids from a cup when your baby is about 6 months old. But your baby should continue to get nutrition largely from breast milk or formula until he or she is 12 months old. After that, allowing your child to continue drinking from a bottle may lead to problems such as bottle mouth tooth decay.
• Whether to give a vitamin D supplement. If you are bottle-feeding formula and your baby drinks at least 16 fl oz (470 mL) each day, he or she does not need a vitamin D supplement.³ (Babies who are breast-fed exclusively need vitamin D supplements before 2 months of age.)

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Author:	Debby Golonka, MPH	Last Updated: August 16, 2007
Medical Review:	Adam Husney, MD - Family Medicine Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics Michael J. Sexton, MD - Pediatrics
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