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When is bottle-feeding with formula the best choice for your baby?

If you are having a hard time breastfeeding and are trying to decide whether to use formula, know that the first few weeks of breastfeeding are the most challenging. You may want to talk to your healthcare provider to help you make your choice. Some moms choose to both breastfeed and bottle-feed their babies.

While breast milk is the ideal food for babies, your baby can get good nutrition from formula. Formulas are designed to give babies all the calories and nutrients they need until they are 6 months old and start to eat a variety of solid foods. When your baby starts eating solid foods continue to offer formula.

What are your choices for infant formula?

There are many types of iron-fortified infant formulas for you to choose from. Almost all infant formulas have some iron in them. If your baby is at risk for low iron, talk to your healthcare provider about the type of formula your baby needs. Most of the time, parents start with formulas made from cow's milk.

Formula-fed babies can become iron-deficient if iron-fortified formulas are not used. Not getting enough iron may lead to serious problems in babies, such as weakness, abnormal digestion, and learning problems.

Talk to your healthcare provider before you try other types of formulas, including:

• Soy formulas. These formulas are used by parents who whose infants have galactosemia. Soy formula may also be chosen for cultural, ethical, or religious reasons.^{footnote 1, footnote 2}
• Lactose-free formulas. These formulas are used for babies who are lactose-intolerant, which means that they can't digest lactose, a natural sugar found in foods with cow's milk. Most of the time, lactose intolerance starts in later childhood or adulthood. It is rare in babies.
• Partially hydrolyzed formulas. The milk protein in partially hydrolyzed formula is broken down into smaller parts.
• Extensively hydrolyzed protein formula. The milk protein in extensively hydrolyzed formulas is broken down into its smallest parts. These formulas are only used in special cases and are not usually used for healthy babies.^{footnote 1}

Formulas for toddlers are also available. These formulas have extra nutrients, and you can use them to help your child make the switch to whole milk. But healthy babies and toddlers don't really need them.

Do not use homemade formulas, such as those made with evaporated milk or raw milk. Homemade formulas do not contain the nutrients, vitamins, and, minerals your baby needs. They could also make your baby sick.

How do you feed formula to your baby?

When you make formula, use a safe source of water and be sure your hands and equipment are clean. Follow the advice of your healthcare provider and read the label on the formula package. Make sure the formula is not too hot or too cold when you give it to your baby.

The length of time between feedings varies. As you get to know your baby, you will be able to notice his or her signs of hunger and fullness. Don't hesitate to call your healthcare provider if you are worried about whether your baby is eating enough.

After formula is mixed, it needs to be used within 24 hours to be safe. Throw away any formula left in the bottle after you feed your baby, because bacteria can grow in the leftover formula. Reheating or refrigerating won't kill the bacteria.

When is it okay to start giving your baby whole milk?

When your baby is 9 to 12 months old and eating a variety of iron-rich foods, he or she can start to drink pasteurized whole-fat (3.25% Milk Fat) cow's milk. Limit cow's milk to no more than 3 cups (750 mL) per day. If you are not breastfeeding and do not want to give your child cow's milk, give your child soy infant formula until your child is 2 years of age. After age 2, you can serve lower-fat milk or fortified alternatives.

Other kinds of milk such as skim milk, 1% milk, or 2% milk, or soy beverage don't have as many nutrients as whole-fat cow's milk. It is best not to give your baby these beverages, until he or she is 2 years of age.

Promoting Healthy Growth and Development

Buying formula and supplies

Try to buy your formula and supplies before the baby is born. You can buy infant formula as a liquid concentrate or a powder that you mix with water. Formulas also come in a ready-to-feed form, which costs the most. Always use a store-bought formula unless your healthcare provider advises otherwise. If you have questions about which infant formula is right for your baby, talk with your healthcare provider.

When you buy baby bottles and nipples, make sure you have a supply of small bottles [about 4 fl oz (120 mL)] for your baby's first few weeks. You may want to buy a variety of different bottle nipples so you can experiment to see which type your baby prefers.

Preparing infant formula

You can buy formula as a powder or as a concentrated or ready-to-feed liquid. Ready-to-feed formulas cost the most. But some caregivers find their convenience worth the extra cost.

You must add, safe water to powders and concentrates. Be sure to follow the directions on the label and use the measuring device that comes with the product. For more information on preparing and handling formula, check your provincial website or see the Healthy Canadians Infant Formula webpage at www.healthycanadians.gc.ca/kids-enfants/infant-care-soins-bebe/formula-formule-eng.php.

Feeding your baby

Always wash your hands before feeding your baby.

• Warm the formula to room temperature or body temperature before feeding. Don't use the microwave. Microwaving formula can cause hot spots in the formula that can burn your baby's mouth. Before you feed your baby, check the temperature of the formula by dropping a small amount on the inside part of your wrist. It should be warm, not cold or hot.
• Place a bib or cloth under your baby's chin to help keep his or her clothes clean. Have a second cloth handy to use when burping your baby.
• Hold your baby in a semi-upright position, with your baby's head resting in the crook of your elbow. Keep your baby's head higher than his or her chest.
• Stroke the centre of the baby's lower lip to encourage your baby to open his or her mouth wider. With an open mouth, the wider part of the bottle nipple will fit, allowing your baby to make a tight seal between his or her mouth and the bottle nipple. This helps reduce the amount of air the baby sucks in.
• Angle the bottle so that the neck of the bottle and nipple stay full of milk. This helps reduce the amount of air your baby swallows while feeding.
• Do not prop the bottle in your baby's mouth or let him or her hold it alone. These practices deprive your baby of time when he or she could be close to you. This may also increase the risks of choking, tooth decay, and ear infection.

During the first few weeks, burp your baby frequently. This helps get rid of swallowed air, reducing the chances of your baby spitting up. Most babies need less frequent burping as they get older.

You will know your baby is full when he or she stops sucking continuously. Usually, as babies get full, they pause frequently during feeding. Also, your baby may spit out the nipple, turn his or her head away, or fall asleep when full. Throw away any formula left in the bottle after you have fed your baby, because bacteria can grow in the leftover formula.

Feeding is a good time for social contact with your baby, so don't rush. Look into your baby's eyes and talk or sing while you are giving the bottle. This contact helps your baby feel close to you and is important for healthy growth and development. Wear a short-sleeved shirt to give more skin-to-skin contact. Sit in a comfortable chair with your arms supported on pillows.

Other concerns

• How to prevent tooth decay. Clean your baby's gums with a soft cloth or gauze pad to remove plaque before their first tooth comes in.^{footnote 1} As more teeth come in, clean them with a soft toothbrush, with a smear (size of a grain of rice) of fluoride toothpaste. If you are not sure about the fluoride levels in your drinking water, talk to your healthcare provider or dentist. Fluoride supplements are sometimes recommended but must be used with caution. Talk with your healthcare provider about other ways to prevent tooth decay in your young child. For more information, see the topics Teething and Basic Dental Care.
• When to offer liquids from a cup. You can start offering liquids from a cup when your baby is 6 months old. But make sure your baby continues to get nutrition largely from breast milk or formula until he or she is 9 to 12 months old. After that time, try to have your child use a cup instead of a bottle. Work toward a goal of not using a bottle by age 12 to 18 months. This can help your child avoid problems such as bottle mouth tooth decay . And to help prevent injuries from using bottles and cups during unsteady walking, have your child stay seated while drinking.
• Whether to give a vitamin D supplement. Breastfed babies and babies fed some breast milk need 400 IU of vitamin D each day from a liquid supplement.^{footnote 3, footnote 4} Babies who are only fed formula do not need a vitamin D supplement. When your baby is no longer breastfeeding or taking formula, your healthcare provider may recommend a vitamin D supplement. Talk with your healthcare provider about how much and what sources of vitamin D are right for your child.

When to Call a healthcare provider

Call a health care provider if your baby:

• Is not growing and gaining weight as expected.
• Is constipated or if his or her stools are hard and/or dry.
• Is vomiting forcefully and seems to be uncomfortable. When vomiting occurs, all or most of a feeding is thrown up.
• Has diarrhea or skin rash or is vomiting or crying inconsolably. Your baby may have developed a cow's milk intolerance or food allergy.
• Has gas, bloating, cramps, and/or diarrhea after drinking milk or eating dairy products. Your baby may have lactose intolerance.
• Has dark areas on his or her teeth or other signs of tooth decay.

Who to see

For routine medical checkups or problems related to your baby's health, the following health professionals can help:

• Family doctor
• General practitioner
• Pediatrician
• Nurse practitioner
• Public health nurse
• Registered dietitian

For preventive dental care and problems with your child's teeth, see a dentist. Pediatric dentists specialize in the care and problems of children's teeth.

Routine Checkups

Your baby needs routine medical checkups. During these checkups, your baby's height, weight, and head circumference will be measured to find out whether he or she is growing at the expected rate. In some areas, your child may see a public health nurse for routine checkups and immunizations.

At each checkup, talk to your healthcare provider about your baby's nutritional needs, which change as he or she grows and develops. For example, babies 6 months of age may start eating solid foods.

A checkup is a good time to talk about any feeding problems or developmental concerns that you have. You may want to make a list of questions before your visit.

Early and regular dental care is important for your child. Talk with your healthcare provider about how to care for your child's teeth before they start coming in, which is usually between 6 and 12 months of age. For more information, see the topics Teething and Basic Dental Care.