Bottle Feeding With Safety and Love - Part Two

How Much? How Often?
How much formula your baby takes depends upon your baby's weight and rate of growth, metabolism, body type, and appetite. The following guidelines on feeding volumes are meat to satisfy your infant's basic nutritional requirements. Your baby's individual desire may change from day to day and sometimes may be more or less than the average recommended volumes.

You may use the following rule of thumb for how much formula to feed your infant from birth to six months of age: Two to two-and-a half ounces of formula per pound per day (125-150 milliliters per kilogram per day). If your baby weighs ten pounds for example, me may take twenty to twenty-five ounces per day. Don't expect your baby to drink this much immediately after birth. Many newborns need and take only an ounce or two (30-60 milliliters) at each feeding for the first week. Use the following as a general guide:

* newborns: 1-2 ounces at each feeding
* one to two months: 3-4 ounces per feeding
* two to six months: 4-6 ounces per feeding
* six months to a year: up to 8 ounces per feeding

Small, more frequent feedings work better than larger ones spaced farther apart. Your baby's tummy is about the size of his fist. Take a full bottle and place it next your baby's fist and you'll see why tiny tummies often spit the formula back up when they're given too much at one time.

Sometimes baby is thirsty and not hungry. Offer a bottle of water if you think baby may be thirsty. Because formulas are more heavily concentrated than breast milk, it is advised that parents give their baby at least 4 to 8 ounces of water a day (breastfed babies do not need extra water).

Scheduling the Bottle Feeding Baby
Formula-fed babies are easier to schedule than breastfed babies. Because formula is digested more slowly (the protein curds are tougher) the interval between feedings is usually longer for bottle fed babies.

There are two types of infant feeding practices: demand feeding (or "cue feeding"), in which baby is fed every time his little tummy desires, and scheduled feeding, when baby is fed at certain fixed times during the day, usually every three hours, and when awakening during the night. Cue feeding is for infant satisfaction; scheduling is for your convenience. (The term "feeding routine" is preferred rather than the more rigid-sounding term "feeding schedule.") Your overall infant-care routines, especially feeding, are challenging negotiations between baby's needs and yours. Tiny babies have tiny tummies. Most babies do best on smaller, more-frequent feedings. Giving your baby a bottle every three hours (rather than ever four hours) is most in keeping with a balance between baby's satisfaction and parents' lifestyle. Most bottle feeding parents arrive at a compromise, or semi-demand type of schedule, giving baby one or two feedings at specified times each day, interspersed with cue feedings.

During the first few weeks, awaken your baby for feeding if he sleeps longer than four hours during the day. Allowing baby to sleep longer than four hours between feedings during the day may result in the exhausting day-sleeper-and-nigh-feeder routine. Try to arrange for the longer stretches of sleep to occur at night. More frequent feedings during the day and bottles at 7:00 p.m. and 10:00 p.m. generally seem to be the most comfortable feeding routine for most parents This allows parents some free time in the later evening; and giving baby a bottle before you retire will often satisfy baby until 3:00 or 4:0 a.m., requiring just one waking for you.

Reading Your Baby's Cues
Tempting as it is to give your baby a bottle every time he cries, using formula as a pacifier may lead to overfeeding. Learn alternative ways of comforting rather than automatically reaching for formula at the first whimper. Baby may need only holding, a playful interaction, a bottle of water when thirsty, a diaper change, or simply a change of activity. Bottle-feeding mothers actually need more of a variety of baby-comforting techniques than do breastfeeding mothers. Using breastfeeding as a pacifier is less likely to result in overfeeding

Preparing Formula
Always remember to wash your hands thoroughly before preparing formula and baby food, and be sure all the equipment used in preparing formula is clean (see instructions on sterilizing, below). The feeding supplies you will need include bottles, nipples, and miscellaneous utensils.

Bottles.
Start with four four-ounce (120-milliliter) bottles, and after you and your baby have decided on the favorite type of bottle and baby is taking more than four ounces a feeding, you may need as many as eight to ten eight-ounce bottles. Glass is easiest to clean, but breakable. Besides traditional bottles there are plastic nursers, holders with pre-sterilized disposable bags that hold the milk and collapse as baby feeds, lessening air swallowing. For older babies there are clever bottles designed in a loop for baby to hold during self-feeding. The use of these self-feeding bottles is not advised because they encourage baby to walk around holding a bottle and deprive baby of valuable social interaction during feeding.

Nipples.
Latex and silicone nipples come in a variety of shapes and flow rates that are designed to deliver expressed breast milk, formula, or milk in a way that is most comfortable for your baby. For the full-time bottle feeding baby, experiment with various types of nipples to see which one works best for your baby. If baby is both breastfeeding and bottle feeding, see "Combo Feeding: Breast and Bottle," below.

To avoid baby's choking on a nipple, follow carefully the manufacturer's caution advice on the package. If the nipple becomes cracked or torn, discard it. Some nipples come with a variety of hole sizes to fit the type of liquid and the age of the baby. The nipple hole should be large enough for formula to drip at one drop per second when you hold a full, unshaken bottle upside down. Larger nipples and nipple holes are available for older babies.

If your baby is not getting enough liquid through the nipple, you can enlarge the nipple opening by using a needle approximately the same thickness as the hole size you desire. Heat the tip of the needle until red hot and insert the needle through the hole from the inside of the nipple. Pull the needle out of the nipple hole with a quick, straight pull. Repeat if the hole is not large enough Attempt to enlarge the nipple hole in latex nipples only. Do not attempt to enlarge a hole in silicone nipples, as this may cause tearing.

Is Baby Getting Too Little Or Too Much Formula:
Signs that your baby may be getting too little formula are:
* slower-than-normal weight gain
* diminished urine output
* a loose, wrinkly appearance to baby's skin
* persistent crying

Signs that your baby is being fed too much at each feeding are:
* a lot of spitting up or vomiting immediately after the feeding
* colicky abdominal pain (baby draws his legs up onto a tense abdomen immediately after feeding)
* excessive weight gain

If these signs of overfeeding occur, offer small-volume feedings more frequently, burp baby once or twice during the feeding, and occasionally offer a bottle of water instead of formula.

Utensils.
To prepare formula, have the following items on hand.
* punch-type can opener (for canned formula)
* bottle brush
* large pot (with a cover) for sterilizing
* clean towels or dishcloth

Sterilizing
A dishwasher with a water temperature of at least 180 degrees F (82 degrees C) will adequately sterilize bottles and accessories. If not using a dishwasher, try the following sterilization process. (Sterilize six bottles, or a daily supply, at one time.)
* After a feeding, thoroughly rinse the bottle and nipple under warm water and leave them on a clean towel by the sink, ready for your next sterilizing session.
* Wash all the bottles and nipples in hot soapy water using a bottle brush and rinse thoroughly in hot water.
* Pad the bottom of a large pan with a towel or dishcloth. Immerse open bottles and nipples in the pan (place bottles on their side to be sure that they are filled with the sterilizing water) and boil for ten minutes with the pan covered. Allow to cool to room temperature while still covered. Place the bottles upside down in a clean towel with the nipples and caps alongside, Let the equipment dry.

Combo Feeding: Breast and Bottle
Because of the health benefits of extended breastfeeding, many employed mothers choose to continue part-time breastfeeding. Here are some helpful tips on the art of "combo feeding" by both breast and bottle:

Chose a breastfeeding-friendly nipple.
Try nipples that resemble, as much as possible, the shape of your areola and nipple. Use a nipple that has a wide base and gradually tapers down to the nipple, much like the shape your breast takes in your baby's mouth. Also, to ease the transition between breastfeeding and bottle feeding, choose a nipple with a slower flow, which baby is used to during breastfeeding.

Encourage proper latch-on. Be sure baby latches on to the bottle nipple the same way she latches on to your breast. Encourage her to open her mouth wide and to suck on the wide base and not just the top of the nipple. To prevent your nipples from getting sore while breast feeding, don't let your baby learn lazy latch-on techniques while bottle feeding. (See my Articles on Breastfeeding: Why and How)

Get the gas out.
When making the transition from breast to bottle, some babies swallow more air. To minimize this nuisance, try using a bottle feeding system that minimizes air swallowing, such as bottles with collapsible liners that keep the air out as baby feeds.

Ease the combo feeding transition.
While most babies can switch back and forth between breastfeeding and bottle feeding, some get very set in their ways of feeding. So, instruct baby's caregiver to feed your baby in a way that most resembles your baby's preferred pattern of breastfeeding. Warm the bottle nipple in warm water to make it more supple. Instruct the caregiver to interact with your baby during bottle feeding in much the same way you do when breastfeeding. Let her watch you breastfeed while you show and tell her how to make eye contact and relate with your baby during the feeding. Remind your caregiver that feeding time is a time for social interaction. "Nursing" implies both comforting and nurturing, whether by bottler or breast.

Mixing Formulas
Use the following procedure to prepare liquid concentrate or powdered formula. Ready-to-feed formula can be poured directly into a sterile bottle with no mixing (before opening the can, thoroughly clean the top).
* Boil the water for five minutes, then let it cool.
* Align the six sterilized bottles in a row and pour the prescribed amount of cool boiled water into each bottle. (Theoretically, hot water could damage some of the nutrients in the formula.) Add the prescribed amount of liquid or powdered formula. For example, if using liquid concentrate in eight-ounce bottles, pour four ounces of boiled water in each bottle and add four ounces of liquid concentrate.
* Put nipples and caps on each bottle, shake well (especially for powdered formula), then place in refrigerator.

8 Use refrigerated formula preferably within twenty-four hours, or a maximum o forty-eight hours.

The Right Mix
Never mix the formula in greater strength than the directions sate. Always add the specified amount o water. Adding too little water makes for formula too concentrated for your baby's immature intestine and kidneys to handle, causing baby to get dehydrated. Sometimes your doctor may recommend over-diluting the formula during a vomiting or diarrheal illness. Over diluting should not be done for more than a few days without your physician's advice, as over-diluted formula does not provide enough calories for your baby.

Tips for Quick and Easy Sterilizing and Formula Preparation:
* Use disposable pre-sterilized nurser bags to hold the formula in a plastic holder; this is convenient and minimizes air swallowing, as the bag collapses during the feeding.
* Use a dishwasher to sterilize bottles and nipples, and use ready-to-feed liquid formula. No water to boil, no extra sterilizing or measuring needed.

Bottle Feeding Tips
To make feeding time pleasant for you and baby, here's how to get the most milk in and the most air up, and to do it safely.

Giving the Bottle
* Most babies enjoy their formula slightly warmed; run warm tap water over the bottle for several minutes. Shake a few drops on your inner wrist to check the temperature.
* To minimize air swallowing, tilt the bottle, allowing the milk to the nipple and the air to rise above the formula.
* Keep baby's head straight in relation to the rest of the body. Drinking while the head is turned sideways or tilted back makes it more difficult for baby to swallow.
* To lessen arm fatigue and present different views to baby, switch arms at each feeding or after burping midway through the bottle.
* Watch for signs that the nipple hole is too large or too small. If baby gets a sudden mouthful of milk and sputters and almost chokes during a feeding, milk flow may be too fast. Turn the full bottle upside down without shaking. If milk flows instead of drips, the nipple hole is too large; discard the nipple. If baby seems to be working hard and tires easily during sucking, and the cheeks cave in because of a strong suction vacuum, the nipple hole may be too small (as previously mentioned, formula should drip at least one drop per second).
* Know when to quit Babies know when they've had enough. Avoid the temptation to always finish the bottle. If baby falls asleep near the end of the feeding, but has not finished the bottle, stop. Often babies fall into a light sleep toward the end of the bottle, but continue a flutter type of sucking. They have had enough to eat, but enjoy a little "dessert" of comfort sucking. Remove the bottle and allow baby to suck a few minutes on your fingertip.

Burping Baby
Besides the relaxing pat on the back, effective burping requires two actions: holding baby in an upright position and applying pressure on baby's tummy (parents often forget this latter step). With baby seated on your lap, lean her weight forward, with the heel of your hand against her tummy; firmly pat or rub baby's back. Or drape her up over your shoulder and firmly pat or rub her back.

If at first you don't success, try again in a while, If after a minute or two no burp appears, put baby down or carry her upright and go about your business. If baby is content, she doesn't need to burp. If, however, baby is not content after a feeding (squirming, grimacing, and groaning when you lay her down, or refusing to complete a feeding), take these signals to mean that baby needs to burp. Snack-type feedings often skip a burp; big meals usually merit patience until baby burps. Some babies need to burp halfway through a bottle feeding, or after finishing one breast, dubbed "burp and switch."

For nighttime burping, one or two minutes of sucking may not warrant a burp but a big feeding usually does. If you are not in the mood for nighttime burping, try putting baby down immediately after feeding. If she is content, no burp is needed. If she squirms as if uncomfortable, a trapped air bubble is probably causing discomfort. To avoid sitting up and going through the whole burping ritual, continue lying down but drape baby over your hip as you would over your shoulder. The need to burp lessens as baby gets older.

Try the one-arm burp. If you don't have time to sit and wait for your baby to burp, drape baby over your forearm so that your wrist presses against his tummy. Carry baby in this position while you stroll around the house. The only drawback is that spit-u may dribble onto your arm or the floor.

Safe Feeding Tips
* If you question the safety of your tap water, use bottled water.
* Do not microwave formula; there is too great a risk of heating unevenly.
* It is all right to reuse leftover formula within a few hours if it is immediately refrigerated after the first use. Cap the bottle to keep the nipple clean. For maximum safety, however, do not reuse leftover formula, because bacteria may have been introduced through baby's saliva.
* If you are traveling and refrigeration is not readily available, pre-sterilized, ready-to-feed four-ounce cans of formula are the safest and easiest. Powdered formula takes up less space, but use only if clean water is available. If taking along home-mixed formula, store it in insulated containers with a small ice pack.
* Do not bottle prop. Don't let your baby lie in a crib feeding himself with his own bottle. Leaving a baby unattended during feeding is potentially dangerous if the baby chokes and needs your help. Also, lying down during feeding allows milk to enter the middle ear through the Eustachian tube which can trigger ear infections. (This is less true for breastfeeding.) Bottle propping deprives both you and your baby of the valuable social interaction that occurs during feeding.
* Lessen the number of nighttime bottles once baby has teeth.

Weaning Baby From The Bottle
Like weaning from the breast, there is no rush. It is not unusual or abnormal for baby to still want a bottle at two years of age. Bottles bother adults more than toddlers. If you wean your baby to a cup early, be prepared to let him continue to use a pacifier to meet his sucking needs. The nighttime bottle is the most difficult to part with. Wean baby from nap and night bottles by a trick called watering down. (Gradually dilute the bottle contents with increasing amounts of water until baby figures out it's not worth waking and up and fussing for a bottle of water.)

Continued use of bottles beyond eighteen months to two years can lead to two problems:
1. Tooth decay. If your toddler falls asleep with a bottle in his mouth, the unswallowed milk will remain on his teeth. The milk sugar can begin to cause tooth decay. To prevent this, remove the bottle before he falls asleep.
2. Overbite. Using a bottle beyond two years can begin to reshape the upper gum line and palate. This can lead to an overbite and buckteeth.

If your toddler is still using a bottle, ask your doctor to check his teeth for these changes. There is no set time that is best to wean every child off the bottle. Here are some suggestions to help you choose what time is appropriate for your child:
* When transitioning your baby from formula to whole milk, try giving whole milk in a cup only. This way, when baby is off formula, he's also off the bottle.
* Remember the toddler mind-set: Just try weaning a two-year-old off the bottle! Many parents find it easier to wean an infant between twelve and eighteen months before the stubborn steak sets in.
* If your toddler is a picky eater and not yet skilled in cup drinking, allow daytime bottles of milk or formula (a maximum of four eight-ounce bottles, about one liter) to ensure enough nutrition. When he is cup skilled and consistently eating a balanced diet of solids, gradually wean from bottle to cup.
* Have a "you can't walk around with your drink" policy. Discourage bay from walking around with a bottle. Some juice addicts cling to this sticky companion. Not only will there be trails throughout the house, but this habit, bad for nutrition and harmful to teeth, is hard to break.
* If baby has a love affair with the bottle and needs it for a pacifier, gradually "lose" the bottle and substitute other "pacifiers," preferably human ones.

A Person At Both Ends Of The Bottle
The term "nursing" means comforting and nourishing, whether by breast or bottle. Feeding time is more than just a time for nutrition. It is also a time for special closeness. The mutual giving that is a part of breastfeeding should also be enjoyed during bottle feeding. Besides giving your infant a bottle, give him your eyes, your skin, your voice, and your caresses. Baby will return to you more than just an empty bottle.

The special warmth of skin-to-skin contact can be accomplished by wearing short sleeves and partially undressing yourself and your baby when feeding. Hold the bottle alongside your breast as though it were coming from your body, and look into your baby's eyes. Interact with your baby during a feeding. You want your baby to feel that the bottle is part of you. Most babies, breastfed and bottle fed, feed better if you are quiet while they suck, but babies enjoy social interaction during pauses in the feedings. Watch your baby for signals that he wants to socialize during the feeding. Eventually you will develop an intuitive sense of your baby's feeding rhythm. Baby should feel that a person is feeding him, not just a bottle.

There will be more articles on infants, breast or bottle feeding and other related topics to follow. So please keep an eye out for more of my articles.