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Health considerations when bottle-feeding

If you decide not to breastfeed, or are unable to breastfeed, commercial iron-fortified formulas can provide adequate nutrition for your infant. Infant formulas contain adequate amounts of protein, calories, fat, vitamins, and minerals for growth. However, formula does not contain the immune factors that are in breast milk. The immune factors that are found in breast milk can help prevent infections.

Picture of a baby feeding himself a bottle

Infants who take enough iron-fortified infant formula usually do not need vitamin and mineral supplements. However, the American Academy of Pediatrics recommends vitamin D supplementation for all breastfed babies and for those babies drinking formula until their intake exceeds about 32 ounces a day.  Fluoride is sometimes needed after six months of age if the water supply does not have enough fluoride. Check with your baby's doctor about fluoride supplements. Types of infant formula include:

  • Cow's milk-based formula. Most infants should be able to tolerate a standard cow's milk formula that is recommended by your child's doctor. These formulas use cow's milk as a base, but have been modeled after breast milk. These formulas have lactose as the carbohydrate (sugar) source. They are available in ready-to-feed cans, liquid concentrate, and powder. Regular cow's milk is not an appropriate source of nutrition for a baby.

  • Soy-based formulas. Soy-based infant formulas can provide adequate nutrition for your infant and can be used if an infant requires strict elimination of lactose from the diet. Soy formulas do not contain lactose as the sugar source. Sometimes, soy formulas are used if your infant is not tolerating cow's milk protein. However, infants who are allergic to cow's milk formula can also be allergic to soy-based formulas. Consult your baby's doctor before changing his or her formula.

  • Protein hydrolysates. These are special formulas usually used if your baby is unable to tolerate standard infant formula. These formulas are more expensive than standard formulas. Often these formulas are used if your baby has a cow's milk protein allergy or if he or she is unable to digest a standard infant formula. Consult your doctor before using these formulas.

  • Low iron formulas. Standard cow's milk-based formulas are also available in low iron forms. Iron is a very important mineral for growth and development. A lack of iron in the diet can cause iron deficiency anemia. Many people think that the iron in formula can cause constipation, however, this is not true. Low iron formulas should not be used unless recommended by your baby's doctor.

Helpful hints for feeding your baby:

  • Breast milk is best for your baby and is beneficial even if you only nurse for a short amount of time or part-time.

  • Wait until breastfeeding is well established (usually by 3 to 4 weeks of age) before introducing a bottle, unless instructed otherwise by your child's doctor.

  • Working mothers can use a breast pump on break time and refrigerate or freeze the milk for later use as a bottle-feeding. Refrigerated breast milk should be used within 24 hours after pumping. Frozen breast milk is good for several months in the freezer. Fathers and other family members can be involved in feeding time if breast milk is offered from a bottle periodically.

  • Offer cow's milk-based formula with iron as first choice of formula if not breastfeeding.

  • Keep your baby on breast milk or baby formula until he or she is 1 year old. After this time, you may switch to whole milk. Children under 2 years should not drink skim or low-fat milk.

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