What are the choices for feeding my baby with a bottle? 

•    Pump milk from your breasts and feed your baby breast milk from a bottle

•    Feed your baby formula from a bottle

•    Feed your baby both breast milk and formula from a bottle

What should I know about breast milk? 

You can still give your baby breast milk even if you choose to bottle feed him. The La Leche League International(http://www.muruhui.org/mrxx.asp) encourages breast milk as the only source of nutrition for your baby during his first 6 months. They do not recommend that you add other foods to your baby's diet until he is 6 months old. They encourage you to give your baby breast milk until he is at least 1 year old. 

•    Breast milk has the right amount of nutrients (protein, fats, carbohydrates, vitamins, minerals) and water your baby needs. Breast milk also has antibodies that formula does not have. Antibodies help prevent your baby from getting sick

•    Breast milk may be given as soon as it is pumped. Formula needs to be mixed and may need to be warmed before you feed it to your baby

•    Breast milk does not cost anything

•    Your doctor can give you information on how to pump and store your breast milk

What are the 3 basic kinds of formula? 

Baby formula has all the nutrients your baby needs to grow. Ask your baby's pediatrician which formula is best for him. 

•    Cow's milk formula: Most babies drink cow's milk formula. The cow's milk in formula is safe and easy for your baby to digest. You can buy it with or without iron. Some babies do not have enough iron in their bodies. Your baby's pediatrician may suggest giving your baby formula with iron until 1 year of age. Formula with iron will cause your baby's bowel movements to be black. This is normal

•    Soy formula: Soy formula has a different type of carbohydrate and protein than cow's milk formula. You may need to give your baby soy formula if he is allergic to cow's milk formula. You may also need to feed your baby soy formula for a while if he has diarrhea. Most soy formulas have iron and cost about the same as cow's milk formula. Your baby's pediatrician will tell you how long you should feed your baby soy formula

•    Other formulas: You baby may need a special type of formula if he cannot have cow's milk formula and soy formula. Premature babies or babies with health problems may need to drink special formula. Special formulas cost more money than soy or cow's milk formula. Carefully follow the instructions when you mix and prepare a special formula

How is formula supplied? 

•    Ready-to-drink formula:This formula can be poured from a can into a baby bottle and is ready for your baby to drink. Ready-to-drink formula is easy to use, but is the most expensive. Always wash with soap and water, rinse, and dry the tops of formula cans before you open them. Shake formula containers well before you open them. Do not use or buy any damaged formula containers or formula with an expiration date that has passed

•    Formula that must be mixed with water: This liquid formula does not cost as much as ready-to-eat formula. It is very important that you add the right amount of water to this formula. Carefully follow the instructions on the package to mix the formula correctly. Water from a tap may be not be safe to feed your baby. Ask if you should mix with the formula with bottled water or if you should boil tap water before using it

•    Formula powder: 

  o   This formula can be bought in cans or packets and is mixed with a specific amount of water. Formula powder costs the least amount of money. A measuring scoop comes in each can. Use the scoop when measuring the amount of powder to add to water. Formula powder is lightweight and easy to carry with you

  o   Follow the package instructions. Always use the correct amount of formula and water. If you do not add enough water, the formula may cause your baby to be constipated. If you add too much water to the formula powder, he will not get enough calories. He will not gain enough weight

  o   Store formula powder with a tight lid

Do I need to warm the formula or breast milk for my baby? 

•    Most babies enjoy drinking warm formula or breast milk. You may warm it by putting the bottle in a pan of hot water. Another way to warm the formula or breast milk is to run hot water over the bottle. Do not warm it in a pot on the stove, because it may curdle. Shake the bottle and then spray the liquid on the inside of your wrist before you give it to your baby. The temperature should be slightly warm and comfortable to your skin. It should not be hot

•    Do not use a microwave oven to heat formula or breast milk. A microwave oven overheats the liquid in the center of the bottle. The liquid may just feel warm when you test it, but it may be very hot in the bottle's center. The milk may burn your baby's mouth when he drinks it

•    Always throw away any leftover formula or breast milk. Leftover formula or breast milk that has not been refrigerated can grow germs and make your baby sick. Do not feed your baby breast milk or formula left at room temperature for more than 1 hour. Do not freeze ready-to-eat or premixed formula

What kind of bottles should I use? 

•    There are many types of bottles. You may use glass bottles, plastic bottles, or plastic bottles with a plastic liner. Plastic-lined bottles are easy to use and keep your baby from swallowing too much air. Do not use glass bottles when your baby is old enough to hold his bottle. The glass bottle may break and cause injury

•    Bottles come in many sizes. A smaller bottle may be easier to use for babies under 4 to 6 months old. Wash bottles well using a bottle brush and hot, soapy water after each use. Some bottles may be washed in a dishwasher

What kind of nipples should I use? 

•    There are different types and sizes of nipples that may be used in bottle feeding. Talk to your baby's pediatrician about the kind of nipple you should use to feed your baby. Your baby may need a special nipple if he has trouble sucking or swallowing

•    Always check the size of the hole in the nipple. Turn the bottle upside down and shake it. This will show you if the formula or breast milk is coming through the nipple at the right speed. The flow is okay if you get a little spray of liquid, and then a few drops. The liquid is flowing too quickly if it pours or spurts out. It is flowing too slowly if only a drop or two comes out

•    Your baby will give you clues about the milk flow if you watch him suck. He may choke or gulp if the nipple hole is too large. The flow may be too fast if milk leaks out of the corners of his mouth. He may have to suck harder if the nipple hole is too small. This can cause him to swallow a lot of air. He may also stop sucking or act fussy during a feeding if the nipple hole is too small

•    Carefully wash the nipples in hot, soapy water and rinse them well after every feeding

How much formula or breast milk should I give my baby? 

•    The amount of formula or breast milk your baby drinks may change with each feeding and each day. The amount your baby drinks depends on his weight, how fast he is growing, and how hungry he is

•    Your baby may want to drink a lot one day and not want to drink much the next. Let your baby tell you when he has had enough to drink. Do not keep feeding your baby after he shows signs that he is no longer hungry. He may turn his head away, seal his lips, spit out the nipple, or stop actively sucking. Your baby may fall asleep near the end of a feeding. If this happens, do not wake him to finish the formula or breast milk

•    Amount of formula or breast milk your baby should drink: 

  o   Babies up to 2 months old: Your baby will drink about 2 to 4 ounces at each feeding. He will probably want to drink every 3 to 4 hours. Wake your baby to feed him if he sleeps longer than 4 to 5 hours

  o   Babies 2 to 6 months old: Your baby should drink 4 to 5 bottles each day. He will drink 4 to 6 ounces at each feeding. When your baby is 2 to 3 months old, he may begin to sleep through the night. When this happens, you may stop waking up to give your baby formula or breast milk in the night. If you are giving your baby breast milk, you may still need to wake up to pump your breasts. Store the milk for your baby to drink at a later time

  o   Babies 6 to 12 months old: Your baby should drink 3 to 5 bottles every day. He may drink up to 8 ounces at each feeding. You may increase the time between feedings if your baby is not hungry. You may also start to feed your baby foods at 6 months. Ask your child's pediatrician for more information about the right foods to feed your baby

How often do I feed my baby and how long should each feeding take?

Feed your baby on demand. This means feed your baby every time he seems hungry. He may be more alert, make sounds with his lips, move around more, or stick out his tongue. He may also place his fist in his mouth and suck on it. Crying is a late sign of hunger. Your baby should eat on demand about every 2 to 3 hours or 8 to 12 times a day. Each feeding should take about 20 minutes. Feedings may take longer if your baby has a medical problem or has trouble sucking or swallowing.

How do I hold my baby during feedings?

Feeding time is a special time for you and your baby to enjoy and get to know each other. It should be a time for you to relax and to show love to your baby. Talk, smile, touch, or sing to your baby while you feed him. 

•    You may be comfortable feeding your baby while sitting in a rocking chair or an armchair. Put a pillow under your arm for support. Gently wrap your arm around your baby's upper body, supporting his head with your arm. Be sure your baby's upper body is higher than his lower body

•    You may need to help your baby open his mouth to grasp the nipple. Do this by stroking the nipple against his cheek near his mouth. To keep your baby from swallowing air, hold the bottle so that liquid fills the bottle neck and covers the nipple

•    Do not prop a bottle in your baby's mouth or let him lie flat during a feeding because he can choke. If he lies down during a feeding, the milk may flow into his middle ear and cause an infection

•    Do not let your baby sleep with a bottle. If he falls asleep while drinking, the milk will pool around his teeth and may cause tooth decay

How do I burp my baby? 

•    Babies tend to swallow air while drinking from a bottle. The air in his stomach may cause him to feel full before he has had enough milk. It may also make him cry or be fussy. Burp your baby after he drinks 2 to 3 ounces of formula or breast milk. Burp him more often if he seems to be unhappy or is spitting up

•    If your baby does not burp, feed him more, and gently try to burp him again. Your baby may not burp every time you try to burp him. This is normal. Your baby may also spit up a small amount of breast milk or formula when he burps. It may smell strong and look curdled. This is normal. You may try any of the following positions to burp your baby:

  o   On your shoulder: Put a clean cloth on one of your shoulders to catch milk that he spits up. Hold your baby against your shoulder. Put one of your hands under your baby's bottom. Gently rub or pat his back with your other hand

  o   Sitting up: Sit the baby on your lap with his head leaning forward. Support his chest and head with your hand. Gently rub or pat his back with your other hand. Your baby's neck may not be strong enough to hold his head up. Until his neck gets stronger, you must always support his head while you hold him. If your baby's head falls backward, he may get a neck injury

  o   Face down across your lap: Put a cloth or towel on your lap. Put your baby face down on your lap. His head should rest on one leg while his stomach rests on the other leg. Gently rub or pat his back with your hand

How do I know if my baby is getting enough formula or breast milk? 

Your baby will show you signs that he is full. He may turn his head away from the bottle or close his mouth. He may fall asleep, or his face, arms, and hands may look relaxed. He should seem calm and satisfied after a feeding. The following can also help you know your baby is getting enough breast milk or formula: 

•    Your baby has several wet and soiled diapers each day: He should have 6 or more wet diapers and 3 to 4 bowel movements each day

•    Your baby is gaining weight: Your baby's pediatrician will check his weight at each visit to see if he is gaining weight as he should. Your baby may lose weight in the first 3 days after birth. By 4 to 5 days old, your baby should start to gain weight

•    Your baby feeds 8 or more times each day: Your baby may let you know when he is hungry. If he does not, you may need to wake him up to feed him

What are signs that my baby may be allergic to formula? 

•    He acts fussy or cries after a feeding

•    He has diarrhea or trouble having bowel movements. The bowel movements may be small and very hard

•    He has a red rash on his face or around his rear end. The rash may feel rough when you touch it

•    His stomach feels full or tight after a feeding. He may cry and pull his legs up to his stomach because he is in pain

•    He vomits after almost every feeding

•    He wakes up often during the night

Should I give my baby anything else to drink? 

Your baby does not need any other liquids besides formula or breast milk for the first 12 months. Formula and breast milk have the right amount of nutrients that your baby needs and are easy for him to digest. Do not give your baby other types of milk, such as cow's milk, goat's milk, or soy milk, until he is at least 1 year old. It does not provide the nutrients he needs and is hard for him to digest. It may also cause him to develop allergies or other health problems. Your baby does not need juice or extra water during the first 12 months of life. Your baby is getting all the water he needs from his breast milk or formula.

Does my baby need extra vitamins or minerals? 

Some babies may need vitamin D, iron, fluoride, or other vitamins and minerals. Ask your baby's pediatrician if he needs any extra vitamins or minerals.

When should I contact my baby's pediatrician? 

Contact your baby's pediatrician if: 

•    Your baby has a temperature of 38°C or higher

•    Your baby has any of the following signs of formula allergy: 

  o   A red, rough rash, usually on the face or around the rear end

  o   Crying after feedings

  o   Vomiting after nearly every feeding

  o   A swollen and tight abdomen after feedings

  o   Fussiness and waking up often during the night

•    You feel your baby is not getting enough breast milk or formula

•    Your baby is 4 or more days old and has fewer than 6 wet diapers each day

•    Your baby is 4 or more days old and has fewer than 3 bowel movements each day

•    You have questions or concerns about bottle feeding your baby

CARE AGREEMENT:

You have the right to help plan your baby's care. To help with this plan, you must learn about feeding your baby. You can then discuss choices with your baby's doctors. Work with them to decide what choices are best for your baby.

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