Infant Bottle Feeding

When a baby is born, some of the first issues addressed are what, when, and how to feed the baby. The choice to bottle or breast feed is an individual decision, based on the mother's preference and lifestyle and what is best for baby. Breast feeding is recommended because it offers many health benefits, however, infant formulas also can provide the infant with good nutrition. A newborn only needs breast milk or formula-no water, juice, or baby foods. The pediatrician or family practice physician will guide the parents about adding other foods to the baby's diet; most introduce cereals at about six months of age. Babies should not have regular cow's milk until after 12 months of age.

Breast Mlk

A breast feeding mother can pump and store breast milk. Plastic milk storage bags designed just for this purpose are available, or you can use clean glass or hard plastic bottles. If the breast milk will be used in a childcare setting, it should be clearly labeled with the baby's name. Extreme care should be taken to ensure breast milk goes to the correct baby.

Unused expressed breast milk can be stored in the refrigerator for 48 hours. Frozen breast milk can be stored in a deep freezer for three months; thawed breast milk can be stored in the refrigerator for 24 hours. To thaw breast milk, place it in the refrigerator about 12 hours prior to use, or place run under cold water. Do not warm or thaw in a microwave.

After feeding a baby, any remaining breast milk in the bottle should be discarded. A lactation consultant should be consulted regarding any further questions or problems with breast feeding or pumping and storing breast milk.

Formula

Choosing a formula can be confusing to parents. There are many types and brands; each formula meets the basic nutritional needs of most infants, but many have unique benefits or shortcomings, just as certain babies have unique nutritional needs. For example, some babies may have difficulties with standard formulas, and should be fed soy-based or lactose-free formulas. The family's pediatrician or family doctor should be consulted about the initial formula choice, and formula changes should not be made without consulting the doctor.

Formula must be prepared properly in order for the baby to receive proper nutrition. Commercial formula is available in three different types: ready-to-feed, liquid concentrate, and powdered. Carefully follow the instructions on the formula package. When using ready-to-feed formula, just open the can and pour the contents into a bottle. Liquid concentrate must be diluted with an equal amount of water. Pour the formula into a pitcher and add the same amount of water; or pour half the amount needed into a bottle, and add the same amount of water to the bottle. Powdered formula comes with a measuring scoop, and each scoop of powder is diluted with two ounces of water.

The formula should always be poured into a clean bottle. Bottles can be washed in the dishwasher, placing the nipples in a special basket. Make sure nipple holes are unclogged. If the family has "well" water instead of purified "city" water, fluoridated bottled water should be used to mix formula. Fluoridated water (fluoride is added to public water systems) is preferred because of the life-long protection it provides for the baby's teeth.

After the formula is opened or mixed with water, it should not be left at room temperature for longer than two hours. Beyond that time limit, it must be stored in the refrigerator. After a baby has drunk from a bottle, any remaining formula should be discarded after 45 minutes.

Heating formula is not necessary; but if heating is desired, the formula bottle should be placed in a pan of warm water (no more than 120° F) for five minutes or less. A microwave oven should never be used to heat formula. Microwave heating can break down proteins in the formula and can cause hot spots or overheating of formula.

Feeding Schedule

A baby should be fed about every three-four hours; usually with three-eight ounces of formula or breast milk, depending on the infant's age. Because a hungry baby should be fed on demand, this is a goal, not a rule. Breast fed babies may need to be fed more often. Signs of hunger are crying, sucking on fist, "rooting" actions, or sucking on a pacifier for a few seconds and crying. Remember, a baby will cry for reasons other than hunger.

If a baby is crying a short time after feeding and not acting hungry, try comfort measures like holding, rocking, swaddling, and a pacifier instead of feeding. If a baby is overfed, it can cause a tummy ache and excessive spitting up; and the baby will continue to be fussy. If the baby finishes bottles and acts hungry again after a short time, try adding more formula to the bottles.

Feeding Problems

A baby should be held in a semi-reclining position while feeding and never flat on her back. Bottles should never be propped in a baby's mouth or given to a baby in the crib. Always hold a baby while feeding. Invert the bottle, making sure that the nipple is full of formula with no air. Air in the nipple will cause the baby to swallow excessive air, leading to spitting up or stomach aches. The baby should be burped about halfway through the feeding and again at the end of the feeding.

Problems with feeding include spitting up and diarrhea due to formula intolerance. If a baby spits up a lot, try burping more frequently (after each 1/2 to one ounce) and holding the baby upright for 30 minutes after feeding. If this does not help and the baby is spitting up a large amount with each feeding, a doctor should be consulted.

If a baby chokes during a feeding, usually she will recover on her own without any assistance. Take the bottle out of her mouth, hold her upright, leaned a little forward. There is no need to pat her on the back or raise her arms.

Parents sometimes wonder whether a baby is being fed enough, especially when breast feeding. A good indication of adequate feeding is the number of wet diapers. A baby older than one week should have at least six wet diapers a day. In addition, a baby receiving adequate nutrition will show steady weight gain. If a baby is not wetting enough diapers or there is a question about adequate nutrition, a doctor should be consulted.

Kay Lyles, RN, BSN

INTERNET RESOURCES

CNN Health Library: www.cnn.com/HEALTH/library/PR/00057.html

Lucille Packard Children's Hospital: www.lpch.org/DiseaseHealthInfo/HealthLibrary/newborn/nfantfed.html

University of Nevada Reno Cooperative Extension: www.unce.unr.edu/publications/FS01/FS0116.pdf

RESOURCES

American Dietetic Association, 120 South Riverside Plaza, Ste. 2000, Chicago, IL 60606-6995; 800-877-1600; www.eatright.org

U. S. Food and Drug Administration, 5600 Fishers Lane, Rockville MD 20857-0001; 888-INFO-FDA; www.fda.gov