Bottle Feeding

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Whether you've decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you're bound to have questions. Here are answers to some common queries about formula feeding.

What supplies do I need?

From formula to bottles, from nipples to sterilizers, the choices can seem endless. But before your baby is born, it's a good idea to hold off buying — or registering for — too much of any one type of feeding product. After all, you may end up having to return them when you find that your baby doesn't like what you've chosen.

To get you through the first week or so, you'll need to have enough formula, water, bottles, and nipples. Burp cloths and a bottle/nipple brush will also come in handy.

Once you get in the swing of feeding your baby, you may find it's worth investing in more or different kinds of bottles, or items that can make the feeding process go a little smoother (like a bottle drying rack). A bottle sterilizer is not necessary, but you should sterilize all feeding supplies before the first use.

What type of formula should I use?

Many different formulas (at a wide variety of prices) are available these days, which can make the process of choosing one a little overwhelming at first.

Ask your doctor about which brands might be best for your baby. You also can talk to other parents of infants about what they use and why. But remember, it's ultimately up to your baby.

The many kinds of formula available today include:

Cow's milk-based formulas, which make up the vast majority of formulas. Most milk-based formulas have added iron, which babies need. Use only iron-fortified formula, unless advised otherwise by your doctor.
Soy-based formulas, for parents who do not want their babies to eat animal protein, or for the very rare babies who cannot digest lactose. Many babies who are allergic to cow's milk also are allergic to the protein in soy formulas, so soy-based formulas generally don't help with milk-protein allergies. Use only iron-fortified formula, unless advised otherwise by your doctor.
Hypoallergenic formulas for babies who can't tolerate the basic formulas, like those with allergies to milk or soy proteins. The proteins in these hypoallergenic formulas are broken down to their basic components and so are easier to digest.
Specialized formulas designed for premature, low birth-weight babies.

Most formulas comes in three basic forms:

Powders that require mixing with water and are the least expensive.
Concentrates, which are liquids that require diluting with water.
Ready-to-use (or ready-to-feed) liquids that can be poured right into bottles. These are the most expensive but are convenient if you're traveling or can't get to a sterile water supply quickly.

All formulas manufactured in the United States have to meet strict nutritional standards from the U.S. Food and Drug Administration (FDA), so just because a formula is name brand (versus generic) doesn't necessarily mean that it's the best for your baby.

Whatever kind you choose, make sure to check the expiration date on all cans and bottles of formula, and don't use formula from leaky, dented, or otherwise damaged containers.

What about formula with DHA or ARA?

DHA (docosahexaenoic acid) and ARA (arachidonic acid) are ingredients that can be found in some, but not all, formulas.

DHA and ARA are polyunsaturated fatty acids (considered the "good" kinds of fat) that may be linked to brain and nerve development and can be found naturally in fish oils and eggs. The fatty acids are also found in breast milk. By putting DHA and ARA in infant formulas, the manufacturers are attempting to imitate breast milk.

But is it beneficial to buy an infant formula with these ingredients? The jury still seems to be out on that. Some studies have indicated that formulas supplemented with DHA and ARA benefit visual and cognitive development. But others haven't shown any significant improvement with DHA and ARA formulas.

What kind of bottle should I use?

Bottles come in different shapes and sizes, can be made of glass or plastic, and may be reusable or have disposable liners inside. Some babies do better with certain shapes or bottles with liners on the inside. You may need to try a few different brands before you find the one that works best for you and your baby.

It's important to note that some plastic bottles are labeled "BPA-free"— meaning that they do not contain the chemical bisphenol A, which is found in some plastics and may affect kids' health. Glass bottles are free of BPA and can last for a long time, but can crack and chip, so they need to be checked often to avoid harm to your baby.

What kind of nipple should I use?

Walk down the nipple aisle in your local baby center and it's easy to be completely overwhelmed. For starters, nipples come in silicone (clear) or latex (brown). But the options don't end there.

The many different varieties include orthodontic nipples, rounded nipples, wide-based nipples, and flat-top nipples, just to name a few. And some are advertised as "being closer to the natural shape of a mother's breast." But which kind is best really depends on your baby and what he or she seems to prefer. After all, every baby is different.

Nipples also often come in different numbers, "stages," or "flow rates" to reflect the size of the nipple's hole, which affects the flow (i.e., slow, medium, or fast) of formula or breast milk. For example, fast flows may cause younger babies to gag or may simply give them more than they can handle, whereas slower flows may frustrate some babies and cause them to suck harder and gulp too much air.

But whether these different flows are necessary depends on each baby. Your little one may seem to prefer variety or may be content throughout infancy to use the same kind and size of nipple. If your baby seems fussy or frustrated with the nipple, you can certainly try a different kind (like one with a larger hole) to see if it makes any difference.

How often should nipples be replaced?

That depends on how the nipples you're using hold up to cleaning, sterilizing, and everyday use. Be sure to check them regularly for signs of wear and replace them often. Also, as your baby grows, he or she might prefer nipples that come in different sizes and flows (the holes get bigger as babies get older and are ready to handle faster flows of milk).

Formula can be pricey. Any way to cut costs?

Just as you may do already for your groceries and other baby supplies, shop around for the best deals on the formula you've chosen:

Take advantage of all of the free samples and coupons you get in the mail the first few months after your delivery. Many times, new moms are placed on mailing lists for everything baby-related, from children's book clubs to formula companies.
Clip coupons. You may even want to save some for different kinds of formula, in case you end up changing your baby's formula for some reason.
See if your child's daycare has a coupon exchange program in which parents bring in their coupons and other moms and dads take what they need.
Sign up for online coupon clubs that allow you to print and save coupons for only the things you indicate you need.
Sign up for formula companies' clubs and special programs (through the mail or online) that may offer discounts, coupons, and/or free formula and other products.
Compare prices on formula at online retailers. Some online stores have special "mom" clubs that allow you to save regularly on certain products every month, especially if you join a subscription service.
Check for specials at your local grocery stores and/or baby retailer.
See if your local wholesale/bulk items store offers your baby's formula for cheaper than local grocery stores. But don't automatically expect it to be less expensive in the long run just because it comes in a bigger container. When you're buying in bulk — or in bigger sizes — be sure to do the math on how much you're spending per ounce. Sometimes, it may seem like a deal when it really isn't.

How often should I feed my baby?

It's generally recommended that babies be fed whenever they seem hungry, which is called demand feeding (or feeding on demand).

Most newborns who are formula-fed feed every 2 to 3 hours. As they get bigger and their tummies can hold more milk they usually eat every 3 to 4 hours.

And if your baby is very young, or having problems gaining weight, you shouldn't go too long without feeding, even if it means waking your baby. In this case, talk to your doctor about how often your baby should be fed.

How do I know my baby is hungry?

Signs that babies are hungry include:

moving their heads from side to side
opening their mouths
sticking out their tongues
placing their hands, fingers, and fists to their mouths
puckering their lips as if to suck
nuzzling again their mothers' breasts
showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)
crying

Despite what you might think, crying is a late sign of hunger. You should give a feeding before your baby gets so hungry that he or she gets upset and becomes difficult to calm down.

It's also important, however, to realize that every time your baby cries it is not necessarily because of hunger. Sometimes babies just need to be cuddled or changed. Or they could be overstimulated, bored, or too hot or too cold. If your baby cries only an hour after a good feeding, there may be something else causing the distress.

How much should my baby drink?

In the first few weeks, mix 2- to 3-ounce (60- to 90-milliliter) bottles for your newborn. Gradually increase this amount as you become familiar with your baby's eating patterns and appetite. Here's a general look at how much your baby may be eating at different stages:

On average, a newborn drinks about 1.5-3 ounces (45-90 milliliters) every 2-3 hours. This amount increases as your baby grows and is able to take more at each feeding.
At about 2 months, your baby may be taking 4-5 ounces (120-150 milliliters) at each feeding and the feedings may be every 3-4 hours.
At 4 months, your baby may be taking 4-6 ounces (120-180 milliliters) at each feeding, depending on the frequency of feedings and his or her size.
By 6 months, your baby may be taking 6-8 ounces (180-230 milliliters) every 4 to 5 hours. This also depends on whether you've introduced any baby food.

Why does my baby seem hungrier than usual?

As babies gain weight, they should begin to eat more at each feeding and go longer between feedings. Still, there may be times when your little one seems hungrier than usual.

Your baby may be going through a period of rapid growth (called a growth spurt). These can happen at any time, but in the early months growth spurts often occur at around:

7-14 days old
between 3-6 weeks
4 months
6 months

During these times and whenever your baby seems especially hungry, follow his or her hunger cues and continue to feed on demand, increasing the amount of formula you give as needed.

Is my baby eating enough?

Babies grow at different rates, and at times you may wonder whether your baby is getting enough nutrients to develop properly. To help determine whether your baby is eating enough, follow the schedule of regular well-child checkups so that your little one can be weighed and measured.

In the meantime, your newborn's diapers are a good indicator of whether your baby is getting enough to eat. You'll probably be changing at least six wet and four dirty (soiled or "poopy") diapers each day at first.

Newborns' poop is thick and tarry in the beginning and then becomes more yellow or green as they get older. Formula-fed babies often have firmer, less seedy stools than breast-fed babies.

Wet diapers should have clear or very pale urine. If you see orange crystals in a wet diaper, contact your baby's doctor. Crystals are usually not a cause for concern, but sometimes they can be a sign of a baby not getting enough fluid or of dehydration. Other possible signs of underfeeding include:

not gaining enough weight
seeming unsatisfied, even after a complete feeding

If you're concerned or notice any signs that your baby isn't getting enough nutrition, call your doctor.

Do I need to sterilize my baby's bottles?

Before the first use, you'll need to sterilize nipples and bottles in a rolling boil for 5 minutes. You can also sterilize them with a store-bought countertop or microwaveable sterilizer, but boiling works just as well and costs nothing.

After that, it's not necessary to sterilize your baby's bottles and supplies each time you feed your baby. You will need to wash bottles and nipples in hot, soapy water (or run them through the dishwasher) after every use. They can transmit bacteria if not cleaned properly.

How do I prepare my baby's bottles?

Prepare your baby's formula by mixing water and the appropriate amount of powdered infant formula. The packaging on the side of the formula container will tell you how much to use. Carefully follow the directions. You can use tepid (room temperature) tap water, as long as your local or state health departments have labeled it as safe to drink.

If you're concerned about your water, you may sterilize it to kill germs. Here's how:

pour cold tap water into a teapot or saucepan
place pot on the stove over medium heat
bring water to a rolling boil, and let boil for about a minute
let the water cool until it's at room temperature

Test to see if the water is cool enough for your baby to drink by shaking a few drops of water on the inside of your wrist. If it stings, it's still too hot. Once water has cooled, don't let it sit longer than 30 minutes before adding it to the formula.

Once prepared, the formula is ready to feed to your baby immediately without additional refrigeration or warming. Formula that's been prepared should be consumed or stored in the refrigerator within 1 hour. If it has been at room temperature for more than 1 hour, throw it away. And if your baby doesn't drink all the formula in the bottle, throw away the unused portion — do not save it for later.

Formula may be prepared ahead of time (for up to 24 hours) if you store it in the refrigerator to prevent the formation of bacteria. Open containers of ready-made formula, concentrated formula, and formula prepared from concentrate also can be stored safely in the refrigerator for up to 48 hours.

How do I warm my baby's bottles?

Some babies may actually prefer cold or room-temperature bottles to warm, especially if you start serving them that way from the get-go (which can make things easier for you in the long run).

But if your baby does prefer a warm bottle, remember that the microwave can create dangerous "hot spots" in bottles, so you should never microwave formula.

Instead, you can:

Run the bottle under very warm or hot water for a few minutes.
Put your baby's bottles in a pan of hot water. Just be sure to remove the pan from the heat source before placing the bottle in it.
Use bottle warmers that either sit on your countertop at home or plug into your car's lighter.

Whichever way you choose to heat your baby's bottles, be sure to shake the bottle vigorously. Then test the temperature of the formula by squirting a drop or two on the inside or your wrist before feeding your baby. It should be lukewarm (barely warm) not hot.

When should I prepare the bottles?

Some parents opt to make a bottle just before each feeding, but many others choose to pre-make and refrigerate enough to use for the day. If you know your baby eats every 3-4 hours, for instance, you can make six to eight bottles to last you all day.

If your baby is staying with a caregiver for a long period of time, you may want to prepare just one or two bottles and leave instructions and supplies (bottles, nipples, formula, and water, if necessary) so the caregiver can prepare bottles as needed and not waste any formula. After all, you'll need to throw away any mixed formula that is not used after 24 hours.

How long can mixed formula keep in the fridge?

You should always refrigerate any bottles you fill for later feedings to prevent bacteria from growing, as well as any open containers of ready-to-feed or concentrate formula. Throw away any mixed formula after 24 hours and any open ready-to-feed or concentrate formula after 48 hours.

How long can a bottle keep at room temperature?

Discard any prepared or ready-to-feed formula that's been sitting out after 1 hour.

If formula is left over, can I offer it again?

No, throw away any leftover formula. There's a chance bacteria may have formed since the last feeding, which could make your baby sick.

My baby is fussy after a feeding. How can I help?

Babies can be fussy for a number of reasons. Sometimes it's due to gas, or the the type of formula, bottle, or nipple used, or something else entirely. The tips below may help your baby feel more comfortable.

Walk with your baby or sit in a rocking chair, trying various positions.
Try burping your baby more often during feedings.
Place your baby belly-down across your lap and rub his or her back.
Put a warm towel or warm water bottle on your baby's belly, checking first to make sure it's not too hot.
Hold your baby upright.
Put your baby in a swing — the motion may have a soothing effect.
Put your baby in an infant car seat in the back of the car and go for a ride. The vibration and movement of the car often calm a baby.
Try playing music — some babies respond to sound as well as movement.
Try turning on the dishwasher, clothing dryer, or a white noise machine. The continuous gentle noise may sooth a crying baby.

If your baby continues to be fussy after feedings, talk to the doctor to see what else may be going on. Gastroesophageal reflux disease (GERD), a milk allergy, or another condition can cause fussiness after a feeding.

How do I know if my baby has an allergy?

Some babies are allergic to the protein in cow's milk formula. Symptoms of an allergic reaction may include:

vomiting
diarrhea
abdominal pain
rash
blood or mucus in the baby's stools

Report any of these symptoms to your baby's doctor, and follow his or her advice on switching to a special hypoallergenic formula. But even if the doctor suspects an allergy, don't spend too much time worrying that your child might be allergic forever. Kids often outgrow milk protein allergies within a few years.

Is soy formula safe for my baby?

Most doctors usually recommend giving babies cow's milk formula unless there seems to be an allergy or intolerance, in which case the doctor may recommend soy or hypoallergenic formula. Soy formula — with added iron — is as nutritious as cow's milk-based formula. The problem is that many babies who are allergic to cow's milk are also allergic to the protein in soy formulas, so it may not be helpful in these cases.

Some parents may worry after hearing or reading about certain soy concerns, particularly about phytoestrogens (hormone-like chemicals from plants) that are found in soy formulas. These concerns need to be studied further, but so far research has not found definite evidence that soy formulas negatively affect a child's development or reproductive system.

Soy formula should be used under the direction of your doctor, but it can be an alternative to cow's milk formula for full-term infants. However, soy formulas are not recommended for premature infants.

How do I safely switch to a different formula?

Before making the decision to switch, be sure to talk to your doctor. Parents often assume that formula plays a part in a baby's fussiness, gas, spitting up, or lack of appetite. But often that's not the case.

If your doctor gives the OK to switch formulas, he or she will recommend a way to do it so that your baby's feedings and digestion aren't interrupted. The doctor may suggest mixing the two formulas together little by little, then eventually eliminating the original formula altogether.

Do I need to give my formula-fed baby vitamins?

No. Commercial infant formulas with iron are manufactured to contain all the nutrients your baby needs.

Does my baby need fluoride supplements?

Infants —whether breastfed or formula-fed — do not need fluoride supplements during the first 6 months. From 6 months to 3 years, babies require fluoride supplements only if the water supply is lacking in fluoride. Ask your doctor about what your little one needs.

Is it normal for my baby to spit up after a feeding?

Yes, many infants will spit up a little after eating or during burping because their digestive tracts are immature. This is perfectly normal. Babies may spit up when they:

have eaten too much
burp (the so-called "wet burp")
drool
cough or cry

Some babies spit up often, maybe even after every feeding. If they're happy, growing normally, and don't seem troubled by it, this usually is OK. These babies are called "happy spitters." If you find that your "spitter" seems fussy or uncomfortable after feedings, talk to your doctor to help figure out what's going on. It helps to keep a record of exactly how often and how much your baby spits up to help your doctor diagnose any problem.

Also tell the doctor if your child vomits. Vomiting is not the same as spitting up. Vomiting is a forceful projection of stomach fluids whereas spitting up is a more gentle "flow" of fluids that come up. In rare cases, vomiting is caused by a problem that needs medical attention.

If the doctor says your baby's spitting up is normal, here are some ways that may help ease it:

Burp your little one every 3 to 5 minutes during feedings.
Try giving smaller feedings more frequently.
Hold your baby upright after feedings.
Don't jiggle, bounce, or actively play with your baby right after feedings.
Make sure the nipple hole in your baby's bottle is the right size for your baby. For example, fast flows may cause babies to gag or may simply give them more than they can handle, whereas slower flows may frustrate some babies and cause them to suck harder and gulp too much air.
Keep your baby's head above his or her feet while feeding (in other words, don't hold your baby in a dipped-down position when feeding).
Raise the head of your baby's crib or bassinet. Do this by rolling up a few small hand towels or receiving blankets (or buy special wedges) to place under (not on top of) the mattress. But don't use a pillow under your baby's head, and always put your baby on his or her back to sleep.

Fortunately, many babies grow out of spitting up by the time they're 1 year old.

Is it OK to prop a bottle in my baby's mouth?

No. You shouldn't leave your baby unattended or feeding from a "propped" bottle. Propping a bottle is a choking hazard and also can lead to ear infections and baby bottle tooth decay, a serious dental condition that results from formula (as well as breast milk or juice) pooling in a baby's mouth. Always hold your baby during feedings.

It is OK to let my baby sleep with a bottle?

No. You should never put your baby to bed with a bottle. Like propping a bottle, it can cause choking, ear infections, and tooth decay.

When should I stop bottle feeding?

Many toddlers become attached to their bottles. Besides providing nourishment, bottles also mean comfort and security.

It's important for parents to start weaning babies from bottles around the end of the first year and start getting them comfortable drinking from cups. The longer parents wait to start the transition, the more attached kids become to their bottles and the more difficult it can be to break the bottle habit. Longer bottle use may lead to cavities or cause your child to drink more milk than he or she needs.

Switching from bottle to cup can be challenging, but these tips can make the change easier for parents and kids.

Timing the Transition

Most doctors recommend introducing a cup around the time a baby is 6 months old. In the beginning, much of what you serve in a cup will end up on the floor or on your baby. But by 12 months of age, most babies have the coordination and hand skills needed to hold a cup and drink from it.

Age 1 is also when doctors recommend switching from formula to cow's milk. It can be a natural transition to offer milk in a cup rather than a bottle.

If you're still breastfeeding, you can continue feeding your baby breast milk, but you may want to do so by offering it in a cup.

Tips to Try

Instead of cutting out bottles all at once, try eliminating them gradually from the feeding schedule, starting at mealtimes.

For example, if your baby usually drinks three bottles each day, start by eliminating the morning bottle. Instead of giving a bottle right away, bring your baby to the table and after the feeding has started, offer milk from a cup. You might need to offer some encouragement and explanation, saying something like "you're a big boy now and can use a cup like mommy."

As you try to eliminate the morning bottle, keep offering the afternoon and evening bottles for about a week. That way, if your child asks for the bottle you can provide assurance that one is coming later.

The next week, eliminate another bottle feeding and provide milk in a cup instead. Try to do this when your baby is sitting at the table in a high chair.

Generally, the last bottle to stop should be the nighttime bottle. That bottle tends to be a part of the bedtime routine and is the one that most provides comfort to babies. Instead of the bottle, try offering a cup of milk with your child's dinner and continue with the rest of your nighttime tasks, like a bath, bedtime story, or teeth brushing.

More Strategies

Here are some other tips to keep in mind:

Spill-proof cups that have spouts designed just for babies (often referred to as "sippy cups") can help ease the transition from the bottle. Dentists recommend sippy cups with a hard spout or a straw, rather than ones with soft spouts.
When your child does use the cup, offer plenty of praise and positive reinforcement. If grandma is around, for example, you might say, "See, Emma is such a big girl she drinks milk in a cup!"
If you keep getting asked for a bottle, find out what your child really needs or wants and offer that instead. If your child is thirsty or hungry, provide nourishment in a cup or on a plate. If it's comfort, offer hugs, and if your child is bored, sit down and play!
As you're weaning your baby from the bottle, try diluting the milk in the bottle with water. For the first few days, fill half of it with water and half of it with milk. Then gradually add more water until the entire bottle is water. By that time, it's likely that your child will lose interest and be asking for the yummy milk that comes in a cup!
Get rid of the bottles or put them out of sight.

If you continue to have problems or concerns about stopping the bottle, talk with your doctor.

Reviewed by: Elana Pearl Ben-Joseph, MD

Date reviewed: February 2015