By Sr Teresa Hayward (RM, RN, Lactation consultant, Infant & Paediatric Nutritionist, Baby Sleep Consultant
Parents often think that bottle-feeding is easier than breastfeeding, but this is not necessarily true.
People seem to think its straightforward – you choose a bottle, choose a formula, fill up the bottle, make yourself comfortable, and give it to your baby. This is not true at all. First, you must choose the right bottle but more especially the right formula. You also need a bit of know how before you mix and give that first bottle.
Whether your formula feeding exclusively or supplementing breastfeeding with formula, there are some things that every parent needs to know which is important for the health of your baby
What is baby formula?
Baby formula is an infant nutrition that is made up to mimic the nutrients of human breast milk. In this country we generally use Powdered formula, although pre-mixed ready to use formula is also available. It contains dozens of important nutrients that your baby needs for optimal growth, including vitamins, minerals, proteins, fats, carbohydrates, calcium and electrolytes. But because every baby is an individual and has different needs, it is not one formula fits all.
Types of baby formula
There are a number of different types of formulas as well:
Milk-based, iron-fortified formula is a cow’s milk-based formula. This contains proteins that are made easily digestible as well as lactose and vegetable oils which substitute those found naturally in milk. Iron is essential for infant growth and development, and it is recommended that babies drink iron fortified formulas until 1yr
Fresh cow’s milk is not recommended for children under 1yr because it doesn’t provide the complete nutrition needed for developing infants.
Hydrolyzed formula is where the protein content of the formula is broken down into smaller proteins and makes it easier for the baby to digest these proteins. It is always important to speak to someone trained in feeding before putting your baby on these formulas.
Soy-based formula are made from soybeans supplemented with vitamins, minerals and nutrients. These formulas differ more from human milk than cow’s milk, they aren’t recommended unless in certain circumstances. Something to remember as well is that babies with a milk allergy will also be sensitive to soy protein. Soy-based formula should only be used in a handful of situations such as the rare instance that a baby can’t tolerate lactose.
Before putting your baby on a Soy-based formula, have your baby assessed by a infant feeding specialist.
Special formula are for babies that require special formulations such as premature babies, babies allergic to cow’s milk and soy formulas and babies with metabolic disorders or GERDS. These infant formulas are not necessary unless they have been recommended by a feeding specialist.
AR formulas fall under this category and should not be used for a normal reflux. They should only be used in the case of GERDS where a baby’s reflux is so bad that they are bringing up more than they are taking in and losing weight.
Organic formula are milk products produced without the use of pesticides, herbicides, antibiotics, or growth hormones.
Probiotic and prebiotic formula are now fortified with probiotics, gut-friendly bacteria that are supposed to prevent diarrhoea in otherwise healthy children.
Formulas made with prebiotics are yet another nutritional option and these may contain man-made oligosaccharides, which occur naturally in human breast milk and can promote a healthy lining in the intestine. Prebiotics are also added to some formulas in order to reduce infections in healthy children.
How to prepare baby formula
Preparing your baby’s formula bottle is an important process as each measurement impacts the nutritional content of the bottle. It is critical to read the instructions on the tin and NEVER EVEN deviate from these instructions. Never add more scoops or less scoops than instructed and never try to do half a scoop, also never use a scoop from another brand or type of formula.
Follow these steps to prepare baby formula:
Wash your hands thoroughly with soap and warm water before preparing formula. And you should clean your countertop, and the bottle and nipple before you use them.
Before opening powdered formula, wash the tops of formula cans with soap and hot water, rinse well and dry.
Start with water. Always pour water in the bottle first and then add the powder. Water should always be preboiled and cooled down before adding powder
Measure precisely. Portion out the exact amount of water and then powder per the manufacturer's instructions. Too much water can create less nutritional formula; too little can tax your baby’s kidneys and digestive tract, resulting in dehydration.
Never dilute formula. It’s tempting to add a little more water to the bottles, either to save money by stretching what you have or if can’t get to the store. But this is dangerous, as watering down formula can cause nutritional deficiencies or seizures.
Shake it. Give the bottle a good shake (rather than stirring it) to evenly distribute powder or concentrate.
Don’t microwave it. It could scald your baby if it's too hot.
Boil water first, then let cool for five minutes. Pour water into a clean bottle, add in formula, put on a teat cap and shake.
Do a temperature check. Test the temperature with a few drops on your wrist before feeding your baby.
Serve quickly. Offer prepared formula within two hours of mixing it or within one hour of the start of a feeding. Not planning on using the bottle right away? Store prepared formula in the fridge ASAP and serve within 24 hours to prevent contamination.
Refrigerate premade formula, too. You can keep bottles of formula in the fridge for up to 24 hours.
Toss leftovers. Any formula left in the bottle after a feeding could harbour bacteria, and will result in the milk going off. Be sure to discard it and don’t be tempted to offer it later in the day.
Clean up again. After each feeding, thoroughly wash and sterilize the bottles and teats.
How much formula should a baby eat?
As a general rule, your baby should be drinking 150mls per kg. For the total amount of milk your baby should be drinking multiple your baby’s weight by 150and divide by 6/number of feeds in 24hrs. The tin of formula will give you a guideline, but this will often be a lot more than your baby needs as their guide starts with a 4kg baby.
Gradually increase the volume per feed as your baby grows. Never force baby to take or finish a bottle. As long as they are growing and putting on weight, seem content, don’t force them to finish more milk.
What is the best baby formula for a newborn?
Always consult with a infant feeding specialist about which formula is best for your baby. She will be able to assess your baby and their needs and point you in the right direction. There is no best formula as every baby is an individual with individual needs
Should baby formula always be warm?
There is no health reason to warm formula, so if you’re weary or it’s the middle of the night, know that room-temperature bottles are perfectly fine. But if you do want to warm a bottle, heat it in a bowl of warm water, run warm water over it or use a bottle warmer.
Never microwave a formula bottle, which can create hot spots that could burn a baby’s mouth or throat, and always check the temp on the inside of your wrist before serving it.
How long can baby formula sit out after it’s mixed?
The safest way to feed formula to your baby is to offer it in a timely manner and store it safely.
A bottle of prepared formula should be used within one hour from the start of a feeding session or within two hours of preparation (if it has been at room temperature). If you’re not giving the bottle to your baby within two hours, refrigerate it and use within 24 hours.
As for that little bit of formula left in the bottle at the end of a feeding? It's safest to throw it out, since the combination of baby saliva and formula can prompt bacteria to grow in the bottle.
Does formula change a baby’s poop?
Generally, formula-fed babies have stool that smells stronger, is darker in colour (it can even be brownish-green) and is firmer than a breastfed babies.
However, poo varies baby to baby and most smells and colours are usually nothing to worry about. Ask the doctor if you’re concerned about stool colours and always call if your little one's poop seems hard and pebbly, much thicker than peanut butter, very watery, red- or black-tinged, or has a white or chalk-like appearance.
Can you switch formulas?
Any formula change for your infant should start with a conversation with an infant feeding specialist, as they can guide you to the best choice.
When do babies stop drinking formula?
Most babies should make the switch from formula to whole cow’s milk around their first birthday, but not before. Cow’s milk is not recommended for babies under 1 as it doesn’t contain the nutrients infants need and can be hard for their sensitive stomachs to digest.
Cow’s milk isn’t as sweet as formula (or breast milk), so the taste might take some getting used to for your newly minted toddler. If she’s a little wary, try making the transition by mixing cow’s milk into prepared formula, slowly increasing the ratio of milk to formula in the bottle (just make sure you premix the formula before mixing it with the milk) until your child has adjusted to all milk. At that point, aim to offer 450mls of cow’s milk daily.
Safety tips when using formula
Baby formula is easier to use than ever. But you still have to be careful when buying, preparing and storing it.
Follow these tips to make sure formula is as safe as possible for your baby.
oVet the container. When selecting formula, always check the expiration date. If it’s expired, recalled or damaged (leaky, dented, rusty or misshapen), don’t buy or use it. Also never use 2nd hand formula as it can be contaminated and extremely dangerous for your baby
Mix it right. Check the label to see whether the formula needs to be mixed with water. If it does, follow the measurements to the letter. Formula that's under-diluted can lead to problems including dehydration, while over-diluted formula can interfere with growth and nutrition.
Be super clean. Certain germs, like Cronobacter, are a possibility in an open container of formula. To fight contamination on counters, the sink, container lids and bottles, clean surfaces and gear well with soap and water. You should also wash your hands for at least 20 seconds before preparing bottles, touching your baby’s mouth or pacifier, and after using the bathroom or changing diapers.
Know your water. Boiling is a good idea for certain health conditions It’s good to know how safe your water is when mixing formula.
Toss leftovers. Bacteria from a baby's saliva can multiply in a bottle, so always discard leftovers. Worried about waste? Prepare smaller servings, such as 2 ounces at a time, and give a refill if she's still hungry.
Keep prepared bottles refrigerated. If you're traveling away from home, store previously prepared bottles in an insulated container or a tightly sealed plastic bag with a small ice pack or a dozen ice cubes. The formula will stay fresh as long as most of the ice is frozen. Don't use pre-mixed formula that's no longer cold to the touch — it'll have to be tossed.
Figuring out the whole formula thing can seem like a lot at first. But take heart and know that once you find a formula your baby likes and you learn about preparation and safe storage, you’ll settle into a good feeding routine. And before you know it, making formula bottles will become second nature.
As an Infant feeding specialist, I am passionate about all things feeding, and am here to guide parents onto the right formula, as well as solving any feeding problems. I can be contacted for an assessment any time.
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