Choosing Formula for Baby: Top Concerns on Formula Feeding Answered

By Lisa Thornton, M.D.

How Do I Choose a Formula for My Baby?

As a pediatrician, “choosing formula for baby” is one of the most common questions I receive in my practice. Breast milk provides the optimum nutrition for a baby, but many women cannot or choose not to breastfeed. In that case, baby formula is a healthy substitute or supplement for babies who need more than mom can produce.

Most pediatricians recommend starting with an iron-fortified formula that contains lactose, the sugar found in cow’s milk. If a baby shows signs of feeding intolerance, the pediatrician may recommend switching to a soy-based formula. As long as you stay with the same type of formula (cow’s milk formula, or soy formula) parents can feel comfortable switching formula brands without difficulty. In other words, you can go for the least expensive baby formula or the one on sale week to week, as long as it is the same type of formula your baby is already being fed. If you want to switch from a lactose-based to a soy-based formula, or to another type formula, you should consult with your pediatrician.

Remember, regular cow’s milk (whole milk) and soy milk do not contain all the nutrients that babies need in the first year of life; these types of milks are not substitutes for infant formula or breast milk. Also, cow’s milk can be harmful to infants under the age of one.

How Much Formula Should My Baby Drink?

A newborn will drink 1 to 2 ounces of formula at a time. After the first two to three days of life, this will increase to 2 to 3 ounces every three to four hours. During the second month, most babies average approximately 3 ounces every three hours. At that point parents may try to give more formula during the day so the baby can begin to sleep through the night. At approximately four to six months of age, babies drink around 4 to 6 ounces every four hours. This will increase to 6 to 8 ounces every four to six hours after six months of age. At that time, most babies will begin taking solid food and formula intake will go back down to about 24 ounces a day by nine months of age.

These are general guidelines. Two of the best ways to know that your baby is getting enough formula is to examine his or her diapers. There should be several wet diapers per day and there should be consistent weight gain at well-baby visits.

Should I Wake My Baby Up to Feed?

Some newborn babies will sleep four to five hours between feedings. This may provide a welcome break for parents, but newborns need a lot of food for growth during the first month of life. After five hours, it’s therefore a good idea to wake baby up to feed. By two months of age, it’s fine to let a baby sleep until he or she awakens for a feeding.

When Will My Baby Sleep Through the Night?

Most newborns will wake up twice during the night to feed. By two to three months of age, one nighttime feeding is usually enough and a typical four-month old can go seven to eight hours without a feeding. A baby who wakes to feed in the middle of the night after six months of age is usually looking for comfort and not nutrition.

How Do I Know When My Baby is Hungry?

Every baby will give the same cues to let parents know when he or she is hungry or full. Your baby will start rooting (turning his or her head to one side and opening his or her mouth as if looking for a breast), sucking on his or her hand, and smacking his or her lips. If all else fails, your baby will cry. When your baby is full, he or she will release the nipple, turn away, and often fall asleep. Don’t force your baby to take a certain amount of food. Sometimes a baby will go through a growth spurt and seem to eat all the time. At other times, a baby’s intake may slow down for a few days. In general, babies don’t over eat or under eat. Babies take what their body needs for nourishment and push the rest away.

Should I Be Concerned about My Baby Spitting Up?

Spitting up is the easy flow of milk from a baby’s mouth often with a burp. Vomiting is when the flow is forceful and often uncomfortable. Almost all babies spit up when they burp during infancy. Sometimes spitting up means your baby has eaten more than his or her stomach can hold, or that he or she has swallowed gas while feeding. There is no need for concern unless your baby isn’t gaining weight or is vomiting frequently. Most babies stop spitting up by the time they can sit up at approximately six months of age.

Try these tips to reduce spitting up:

  • Feed your baby in an upright position.
  • Don’t lay your baby down for at least 30 minutes after feeding.
  • Feed more slowly and burp frequently.
  • Don’t actively play with your baby for 30 minutes after feedings.
  • If you want to put her in the crib to sleep, elevate the head of the bed by putting blocks under the mattress. This keeps your child’s head higher than the stomach and reduces spit up.

How Do I Know if My Baby Has Allergies or Food Intolerance/Sensitivity?

Food allergies vary from mild to severe and some can even be deadly. Food intolerance or food sensitivity can be annoying and uncomfortable, but it is not serious or life threatening. Food intolerance can be confused with food allergy so it is important for parents to know the difference. A food allergy happens when the body’s immune system reacts against proteins found in foods. The reaction usually happens shortly after a meal. Symptoms of a food allergy include hives (red spots that look like mosquito bites), itchy skin, swelling of the face, tongue or lips, breathing problems like wheezing, sneezing, and throat tightness, vomiting and diarrhea, pale skin, light-headedness, and loss of consciousness. A severe allergic reaction is called anaphylaxis and requires immediate medical attention.

Food intolerance means that a baby has trouble digesting a particular food without the involvement of the immune system. If a baby has food intolerance, parents may notice that every time he or she eats or drinks a particular food, he develops gas, bloating, or diarrhea. One of the most common foods that babies have difficulty digesting is lactose, the sugar in cow’s milk and the most common sugar found in infant formulas. If a baby has trouble digesting lactose, your pediatrician may suggest switching to a soy-based formula or even pre-digested formula. This is why it is critical to involve your physician when choosing formula for baby.

There is no way to prevent your baby from developing a food allergy or food intolerance, but it’s best to introduce new foods one at a time with several days between each new food addition. That way if your baby has a reaction, you can quickly narrow down the possible culprits. Allergies can run in families, so parents who have a strong allergic history should watch for similar issues in their baby. Common allergens include:

  • Milk
  • Egg
  • Peanuts
  • Tree nuts (such as walnuts or almonds)
  • Fish
  • Shellfish
  • Soy
  • Wheat
  • Peanuts

Specific needs can vary widely between children, so be sure to consult your pediatrician for guidance about your child’s individual needs. When choosing formula for baby, be sure to discuss feeding options with a healthcare professional.


About the Author

Pediatrician Dr. Lisa Thornton is an assistant professor in the departments of Pediatrics and Surgery at the University of Chicago’s Pritzker School of Medicine. She is a guest host on the ABC News Now web cast “Healthy Life” on ABCNews.com and the former host and medical consultant for the weekly health magazine show, “Health Corner,” which aired on Lifetime TV for 5 seasons.

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