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Formula Feeding

Infant formulas are an excellent food. There are differences between them, but they are subtle. All the formulas approved by the FDA are very good. Much science and development has gone into them over the years so that they are as balanced with nutrients and trace elements are scientifically positive. In the baby boom years after World War II, parents used to make their own formula with Carnation milk cans, Karo syrup and vitamin drops.

Wet nurses are one of the oldest occupations for women. Prior to World War I , if a mother died during childbirth or in the days following of child bed fever, a call for a wet nurse would be sent through the community. Until a wet nurse was found, the baby would be given a concoction of sugar water, cow’s, goat’s or sheep milk, even brandy and cream.

A wet nurse was a servant woman who would “move in” with the family to breast feed and take care of the infant. Wealthy women routinely hired wet nurses. Sometimes, an infant would be sent to live with the wet nurse. Often the wet nurse was a woman whose own child had died of a disease, and she still had milk, or a woman who would wean her own toddler to provide milk to the newborn. This happened to the family that founded Lowell, Massachusetts. Amy Lowell, the matriarch of the family, developed severe mastitis with her first child, and hired wet nurses for subsequent babies. Each wet nurse would stay on to be a nanny or other servant in the family. By the time the last two children were born, the house was so full with children and servants, the last two babies were sent to live with local farmer’s wives who acted as wet nurses. The family would visit the babies on weekends until they were old enough to be safely weaned.

The development of safe nutritious infant formulas is a major medical advance.

There are many reasons moms need formula. For one, breastfeeding is not always as easy as it looks. Many mothers have a lot of trouble latching the baby onto the breast. The newborn can become increasingly more frustrated, and start crying incessantly. A newborn is born with about two days reserve of fluid, but thereafter, he/she can become dehydrated and weak. If the cycle of dehydration is not broken, the baby can soon weaken.

The most common cause of breastfeeding problems is a mismatch between the mom’s breast size and baby’s mouth. For example, a mom with a size D bra size might have trouble latching on a newborn with a small mouth, small tongue or slightly recessed chin. The mom has ample milk, but the baby just can’t extract it. During this time, formula can be given while the mom uses a breast pump to “bring in” her milk. There are many reasons a mother will need to give formula. They should not feel ‘inadequate’, or that they are ‘less of a mother’ because they’re not nursing. The baby will be very healthy and well nourished.

Choosing a Formula

Any of the commercially available cow’s milk based formulas (Similac or Enfamil with DHA) are best for most infants. In hospital nurseries around the country all the infants are given one of these formulas unless there is a strong family history of milk allergy in which a mother might request the baby being given soy.

Most formula companies want parents to believe that they need to keep the baby on the same brand formula. That is usually not the case. There are some babies who will digest one brand better than another, but the vast majority of babies can switch from one cow’s milk based formula to another without problem.

How Much Formula Should a Baby Drink?

A newborn’s stomach is the size of his/her fist. In the first few days of life, most infants will only drink about 2 ounces of formula. In a short time, however, they are usually drinking 3-4 ounces every 3-4 hours. As the baby grows, his/her appetite improves and a one month old will usually drink 4 ounces easily.

By two months of age, some babies will drink much more formula than others. Most will drink about 4-5 ounces every 4 hours. At four months, the baby will usually be drinking 6 ounces per feeding. Some babies stay at 6 ounce feedings while others go to 8 ounces.
The rule of thumb is that a baby should have a minimum of 2 ounces per pound (i.e. a 12 pound baby should have 24 ounces of formula over a twenty four hour period. After six months of age, the baby doesn’t need quite as many calories per pound, and even though the baby is getting “bigger”, his/her formula intake stays about the same.

Between 6-12 months, infants should have at least 16 ounces of formula, but not more than 32 ounces a day. Formula is very high calorie. If a baby drinks too much of it, he/she can develop too many fat cells and become overweight. The 32 ounce limit includes formula used in cereal.

Refrigerate Formula or leave it out of a refrigerator?

If the baby starts a bottle and doesn’t finish it, put it back in the refrigerator. You don’t have to throw it out. It’s good for two days. In the newborn nursery they throw out partially used bottles because they are working with so many babies. If a bottle has been out of the refrigerator or thermos pack for more than four hours, you can throw away the unused formula. Expressed breast milk can be left out of a refrigerator for a much longer period (8-12 hours).

Reasons a Baby Might Need to Use a Low Allergy Formula

Colic

When the baby gets home and is a couple of weeks old, infant colic can appear. This is prolonged crying with gassy distension. Often parents will switch to a “hypoallergenic” formula at this time. For most babies, the fussiness is a due to a developmental immaturity of the intestinal immaturity motility and the baby would be fussy no matter what formula he/she is on. It is worth a trial of “hypoallergenic” formula (Alimentum or Nutramingen) or soy formula.

Eczema

Babies will also be switched to a low allergy formula if they are developing eczema. About 40% of infant eczema is related to food allergens, and a switch to a non-cow’s milk based formula helps many babies. The rash is due to allergy cells directed against one of more of the proteins in cow’s milk. Immune cells along the infant’s intestinal track “cross-talk” with immune cells on the skin, giving the bumps and blotches of eczema.

Blood tinged stools

This can be a symptom of food allergy in young infants. A single blood tinged stool can be an incidental occurrence in any infant, but if it occurs more than once or twice, think food allergy.