Formula-feeding is available as an alternative to breastfeeding (chestfeeding). Some parents are not medically able to breastfeed, and some choose to use formula, either in combination with breastfeeding or alone.
In the hospital, newborns are usually fed shortly after delivery, then ideally on demand thereafter. During the first week after birth, babies take ½ ounce to 2 ounces at a time, gradually increasing to 3 or 4 ounces about 6 to 8 times a day by the second week. Parents should not urge newborns to finish every bottle but, rather, allow them to take as much as they want whenever they are hungry. As infants grow, they drink larger amounts, consuming up to 6 to 8 ounces at a time by the third or fourth month.
The proper position for babies who are bottle-feeding is semi-reclining or sitting up. Babies should not bottle-feed lying flat on their back because milk may flow into the nose or the eustachian tubes (see figure ). Older infants who are able to hold their own bottle should not be put to sleep holding the bottle because the continuous exposure to milk or juice can damage their teeth and lead to cavities.
Commercial baby formulas are available as ready-to-feed sterile bottles, cans of concentrated formula that must be diluted with water, and powder, to which water must be added. Formulas contain a proper balance of nutrients, calories, and vitamins; most are supplemented with iron, and they are easily digested by infants. All formula-fed babies should be given iron-fortified formula to prevent iron deficiency anemia. Iron-free formulas are not recommended.
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Parents who use concentrated formula or powders must carefully follow the directions for preparation. Concentrated and powdered formulas should be prepared with water that has fluoride in it. Formulas are usually made from cow's milk, but other special formulas are available for infants who cannot tolerate cow's milk. If infants cannot tolerate standard formula, the pediatrician may recommend switching to a soy-based formula or a hydrolyzed formula. If infants cannot tolerate a hydrolyzed formula, they may be switched to an amino acid formula. There are no long-term health differences in infants fed either standard or special formula. Plain cow's milk, however, is not an appropriate food during the first year of life.
To minimize the infant's exposure to microorganisms, formula must be fed from a container or bottle that has been properly sterilized. According to guidelines issued by the United States Centers for Disease Control and Prevention, babies under 2 months old and those born prematurely or with a weakened immune system should have their bottles sanitized daily (see How to Clean, Sanitize, and Store Infant Feeding Items). Using a dishwasher or boiling the bottles in a pot of water are both acceptable methods of sterilization. For babies that are healthy and older than 2 months, thorough handwashing of the bottle with soap and a bottle brush after each feeding is usually enough, unless the water in the bottle is known to be nonpotable or comes from an unreliable source. Then the recommended sterilization procedures should be followed. Nipples for the bottles should be sterilized in the dishwasher or in a pot of boiling water for 5 minutes. Disposable plastic liners eliminate the need to sterilize bottles.
Parents should warm formula-feedings to body temperature. Filled bottles (or formula containers, if disposable liners are used) are placed in a warm water bath and allowed to come to body temperature. Babies may be seriously burned if formula is too hot, so parents need to shake the bottle gently to even out the temperature and then check the temperature by placing a few drops on the sensitive skin inside their wrist. Formula at body temperature should feel neither warm nor cold to the touch. Microwave ovens may dangerously overheat formula and are not recommended for warming formula or baby food.
The size of the nipple opening is important. In general, formula should drip slowly out of a bottle held upside down. Larger, older infants want larger volumes of liquid and can tolerate a larger nipple opening.
