Preparing to Feed

The Bottle

There are more bottles on the market than I can count, with more appearing all the time. Each one claims to do one thing or the other – reduce gas, mimic the breast, provide a comfortable feed. The extent to which a bottle will actually achieve these things for your baby is very subjective. However, in the vast world of seemingly endless options, bottles can easily be broken down into but two categories: (1) standard or (2) wide.

From these two categories, you’re mostly dealing with aesthetics – colors, shapes, sizes, plastic, glass, silicone – and popularity. Caregivers tell me all the time that they are using a certain bottle because it came so highly recommended by a friend, family member or online parenting group. I also observe “trendy” bottles come and go.

I can’t begin to tell you how little someone else’s success with a particular bottle will influence to your baby’s particular success with it. Therefore, I do not advise buying bottles in bulk before your baby is born and has settled on his or her preference. In fact, it is wisest to have a few brands on hand before baby arrives.

Generally speaking, babies will latch better and feed easier from a standard bottle. This is the bottle type you want if you have a premature baby, a baby with a weak suck, a baby with a small mouth, a baby with a tongue or lip tie, an exclusively formula fed baby, a baby struggling with a wide-mouth bottle, or a baby with reflux or gas issues (a good latch is easier to achieve with a standard bottle and baby is less likely to take in air from the sides of the bottle).

However, wide-mouthed bottles, often marketed as “breast-friendly” bottles, dominate the market. That’s because their manufacturers know that 8 out of 10 women will choose to breast feed their babies at birth. But they also know that the majority of those will be using a bottle to feed very shortly thereafter. Making their bottle more desirable to the masses, by claiming that it will minimize “nipple confusion,” makes consumers, especially nursing moms, more willing to buy their product.

The theory behind it goes that a baby has to open wider and suck harder to release milk from a wide-mouthed bottle, thus closely mimicking breast feeding. This is supposed to minimize the chance of baby growing to prefer bottle feeding over breast feeding. In other words, making bottle feeding too easy will spoil a baby and make her unwilling to exert the extra work needed to nurse.

The reality is that in hundreds and hundreds of combination (combo) fed babies who I have worked with (babies who use a bottle to feed but also feed from the breast), I have never seen this actually happen. Babies will freely transition from breast to bottle so long as the breast is consistently offered.

The only real reasons to use a wide-mouth bottle are to reduce this idea (idea) of “nipple confusion” or for plain preference. However, if you find that your baby is not happy with this type of bottle, do not fear switching to a standard bottle. It is most important that your baby latches well and feeds freely and comfortably from his bottle. Using a standard bottle to achieve that will not sabotage your breast feeding if you are combination feeding.


Standard or Narrow-Mouthed Bottle

Wide-Mouthed or “Breast-Friendly” Bottles

Questions about things like how to choose a bottle, bottles on baby registries, how many big and small ones, how and when to switch bottles, which bottles we prefer, or worried about how to successfully use a bottle but still nurse? Contact us now

The Nipple

Once you choose your bottle, you’re entering into contract with that bottle’s available nipples. Bottles are sold standard with the brand’s slowest flow nipple, intended for newborns, and you purchase their faster flow nipples from there. For the most part, most brands will have 3-4 nipple stages – Newborn, Slow/Level 1, Medium/Level 2, Fast/Level 3, and in some cases Y-Cut for feeding thickened milk. Additionally, some brands will carry Preemie nipples.

Nipples can be made of different materials as well. Silicone and latex are both popular materials for nipples. Some nipples are firm and some are floppy and collapse easily. Your baby will find preference.

You start your newborn with the slowest flow available with your bottle of choice and increase the speed over time. Most of these nipples will have suggested ages attached to them, but those ages are quite arbitrary. For instance, a baby may require a “Medium” nipple at just two weeks of age, even though the packaging suggests “for babies three months and up”. These suggestions are just that – suggestions – and there is no one-size-fits-all approach.

You will know when it’s time to experiment with a faster nipple flow when your baby, who could previously finish his 3-ounce bottle efficiently in 15 minutes, now requires 20 to 25 minutes and begins stopping and starting to get the job done. What happened in this scenario is that your baby has grown and so has his force of sucking. He is now able to suck so hard that he is actually collapsing the slow flow nipple and hindering his own feeding process. In this situation, upping his nipple flow to Medium (or Level 2) will enable him to once again finish his feed in a timely manner without all the stopping.

Babies will often leak and even choke a bit when a faster flow is introduced. Don’t let this deter you from trying it out at least a few more times. Rarely will a baby take to a faster flow without issues involved. It is a learning process like any other and she will need time to get used to it and adjust her sucking. Remember, she was previously sucking really hard to get food from the slower flow. Latching onto a faster flow and continuing to suck as hard will overwhelm the milk coming at her. She will need a few tries to get used to her new normal. If several feeds later your baby is still struggling to feed from the faster flow, then put the nipple away and try again in a couple weeks.

Questions about things like properly increasing nipple flow to get a better feed, baby gagging or choking on the nipple, why your baby fed from the hospital nipples better, or how to stop the nipple from collapsing? Contact us now

The Formula

To begin, the most straightforward way to categorize American infant formula is as follows: dairy-based, soy-based, hydrolyzed, and hypoallergenic. However, under these categories exist many sub-categories and further definitions.

Dairy-based formula is likely what you think of when you think infant formula. The majority of versions of formula are dairy-based. This simply means that they contain cow’s milk protein. This is NOT “cow’s milk meant for baby cows” being fed to a human baby. It is using cow’s milk PROTEIN as a base, modifying it and adding to it all of the valuable vitamins and minerals that human babies need. Dairy-based formula has been m improved over many decades. It is a nutritionally complete food specially designed for human consumption.

Soy-based formula replaces cow’s milk protein with soy protein, and many of the other ingredients remain similar.

Hydrolyzed formula (partial and extensive) still contains cow’s milk protein but is intended for babies who are experiencing an allergy or intolerance to the cow’s milk protein. A hydrolyzed formula simply contains cow’s milk protein that has been broken down so that it is easier for baby to digest, and unlikely to be detected and cause an allergic reaction (though not impossible).

Hypoallergenic formula, also known as elemental formula, uses amino-acids, which are the building blocks of protein, instead of whole (dairy-based) or partial (hydrolyzed) proteins that can cause an allergic reaction in some babies. These formulas are used to help children with an array of diagnoses, including cow’s milk protein allergy, as well as multiple food protein intolerance (MFPI) and gastroesophageal reflux disease (GERD), in addition to others.

Infant formula comes in three forms: (1) powder, (2) ready-to-feed and (3) concentrated. There are pros and cons to each. Please note that unless you have a premature baby who has not yet reached term, or a baby with specific health complications, it is not necessary to feed a sterile formula. Your baby’s pediatrician can tell you if your baby requires sterile formula.

Price of formula can vary considerably. Buying generic formula from retailers like Walmart, Target, Sam’s Club (and many more!) can save your family hundreds of dollars over the course of your formula feeding. All infant formula in the United States is FDA regulated and meets strict quality guidelines. Generic formula is just as tested, just as safe and just as nutritious as the pricy name brands.

Here is a name brand versus generic cost breakdown of a popular dairy-based powder formula:

Questions about things like which formula to choose, how and when to switch formulas, which formula might be best for your baby, baby is having stool issues, baby is fussy on formula, formula concerns, formula for supplementation, special formulas, or how to afford formula? Contact us now

Safe Preparation

Always be sure to use clean, safe water and clean bottles when preparing formula.

It is not necessary to sterilize bottles. Allowing them to soak in hot, soapy water for 15 minutes and then scrubbing them thoroughly is sufficient. If you have a dishwasher, they can also be appropriately cleaned using a standard cycle.

It is also not necessary to use pre-boiled water to prepare formula if your water supply is safe. For most of those living in the developed world, this will not be an issue. The best way to determine whether or not you need to use pre-boiled water when preparing formula is to contact your local water authority, as well as your baby’s pediatrician. If these sources confirm that the water quality where you live is safe for infant feeding, then there is no need to pre-boil. If these sources confirm that your water is not safe for infant feeding, then you may use bottled water or Nursery Water (sold in stores near infant formula), or choose to pre-boil your water (bottles are prepared after the boiled water has sat and cooled).

Powder Formula Preparation: Always use the scooper that comes with your container of formula. The scooper is designed by the manufacturer to dole out the proper amount of powder, making for safe formula preparation.

Use clean, safe water (see above).

Mix two-parts water to one-part powder. For instance, a four-ounce bottle will require four ounces of water mixed with two scoops of powder. A six-ounce bottle will require six ounces of water mixed with three scoops of powder.

Shake thoroughly until all of the powder has been dissolved.

If you have placed your finger on the nipple while shaking the bottle, rinse the nipple thoroughly before feeding.

*Just shaken powder formula can be very frothy and bubbly, possibly upsetting baby’s tummy. Letting the bottle sit for several minutes, or using a hygienic tool to stir inside the bottle (think clean butter knife), will get rid of these bubbles before you start your feeding.

Ready-to-Feed Preparation:

Shake the ready-to-feed formula container.

Remove the cap.

Pour the amount you need into your baby’s bottle.

Place the cap back on.

Refrigerate the remaining formula and use within 24 hours.

Concentrated Preparation:

Refer to the mixing instructions that come with the product.

Use clean, safe water (see above).

Typically, concentrated formula is mixed in a 50/50 ratio. For instance, a four-ounce bottle will require two ounces of water mixed with two ounces of concentrated formula. A six-ounce bottle will require three ounces of water mixed with three ounces of concentrated formula.

Refrigerate the remaining concentrated formula and use within 24 hours.

Hot? Room Temperature? Does it Matter?

This is going to depend on the baby. In a perfect world, your baby will readily eat a bottle at any temperature. But most have preferences. If you’re supplementing with formula and putting the baby to breast to feed at other times, I find that these babies are more likely to reject cool or room temperature milk. They are accustomed to warm milk from mom and want that from a bottle as well.

Overall, most babies like it warm, but you can feel free to attempt room temperature feedings. Straight from the fridge milk is very cold, especially to newborns, and I don’t advise feeding at that temperature. Refrigerated and re-warmed milk can be warmed only to room temperature; it doesn’t have to be warmed up hot.

How to Heat It Up

If you’re shaking up bottles one-at-a-time, then using warm tap water is the simplest way to serve a warm bottle.

There are also products like the Baby Brezza and BabyNes which will automatically dispense you a warm bottle – you even get to choose the temperature.

However, if you’re refrigerating milk and needing to heat it up, or if you’re using room temperature purified water that needs heating up, you have some choices.

  1. You can use a bottle warmer. There are several brands which vary in price, but these tend to cost around $30. I have experience with several bottle warmers and they are effective – taking about 3-5 minutes to heat the bottle, depending on how warm you want it. They aim to heat evenly, but you will still need to shake or stir your bottle up to make sure there aren’t any hot spots. Stirring instead of shaking helps avoid putting bubbles and air into the bottle.
  2. You can use a cup of hot water. I’ve used this method before and it requires a glass bigger than the baby bottle you’re using. You fill it with very hot water from your tap and let the baby bottle sit in the hot water until it is as warm as you desire. You can also let the hot tap water run over the bottle while it sits submerged in the glass. Again, you will still need to shake or stir your bottle up to make sure there aren’t any hot spots.
  3. Microwaving a baby bottle is not advised because it can cause burns, however it is a common practice and so I address it. Unlike breast milk, microwaving will not seriously alter formula. If you’ve ever reheated food in a microwave, you know that certain spots can get scalding hot while others are still cold; it’s just how microwaves work. If you ever warm a bottle in the microwave make sure you’re familiar with its settings and don’t overdo it. Then make sure the bottle is shaken or stirred very thoroughly.

It’s always a good idea to test the internal temperature of the bottle before feeding it to baby. Once you have warmed and shaken or stirred your bottle, you can hygienically test it by tipping the bottle straight upside down and allowing the milk to drip onto the inner part of your wrist. This is a sensitive part of your skin and if the milk burns or otherwise makes your inner wrist uncomfortable then you need to let the bottle cool before feeding it to your baby.

Safely Storing Unused Formula

Opened ready-to-feed formula, opened or prepared concentrated, and prepared powder formula can all stay refrigerated for up to 24 hours and must then be discarded.

When not refrigerated, a prepared bottle of any formula type can be left out for up to 2 hours. In a very warm and/or humid environment my personal preference is only up to 1 hour.

Once a baby has put her lips to the bottle, the bottle must be finished or discarded within those 1-2 hours. It cannot be refrigerated or re-refrigerated once baby has eaten (even a little) from it. As soon as the baby latches to the bottle, her saliva immediately introduces bacteria and that bacteria begins to multiply. Leaving a bottle out past 1-2 hours, or refrigerating and re-feeding a partially eaten bottle, will allow bacteria to grow to a dangerous level and can make your baby sick.

Questions about things like formula feeding on the go, formula at daycare, making overnight formula feedings easier, mixing formula with breast milk, making large batches of formula, or formula safety? Contact us now