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A Formula For Safe Feeding

By Mary E. Hancock, MSN/Ed RNC-OB, and Jeannette Brown, MSN, RNC-OB, C-EFM

A Formula For Safe Feeding

Experts recommend that infants be exclusively fed breastmilk the first 4-6 months of life. Some 75% of all moms initiate breastfeeding in the hospital, while 25% start with formula feeding their baby either because of medical conditions that prevent breastfeeding or because of personal choice. Life changes, such as the need to return to work, often cause more than half of all moms to supplement with or switch to formula feeding at some point during the first year, according to the World Health Organization.

Formula feeding basics

Your pediatrician will likely have a preference for which formula she or he would advise for your baby. A quick call to the practice should answer your question. Powdered or dry and concentrated liquid formulas require preparation and are less expensive. Ready-to-serve formulas are typically mixed at exactly the right concentrations.

Use distilled, filtered tap, bottled or boiled water at room temperature. Read the label to ensure any bottled water doesn’t contain additives, particularly vitamins and minerals. If you’re using well water, have it tested every 3 months during the first year. Babies who eat formula prepared with well water are at high risk for nitrate poisoning. Annual testing for nitrates is ok after baby’s 1st birthday. Well water containing a nitrate level above 10 should never be used to prepare infant formula.

Be sure to use only the exact amount of water specified with dry and concentrated liquid formulas. Adding too much water dilutes the formula, thereby diluting nutrients and calories. This can lead to undernourishment, insufficient weight gain and possibly water intoxication, which can cause hyponatremia and seizures.

Not adding enough water concentrates the nutrients and calories, which can overwork your baby’s immature kidneys and digestive system, causing dehydration and slower growth.

You may be tempted to reach for a soy-based formula, particularly if you want a vegetarian-friendly option, but according to the America Academy of Pediatrics, these should be used only in babies with galactosemia or congenital lactose deficiency. While soy formulas are heavily marketed to resolve colic, research doesn’t bear this out. Most colic resolves by ages 4-6 months.

Anxious to grow a brainy baby? Formulas with the brain-boosters ARA and DHA are also heavily marketed, but research to date is inconclusive about whether these more-expensive supplements actually aid baby’s brain.

Watch for harmful additives as well: In 2008, formula manufactured in China was found to contain melamine, which can harm an infant’s kidneys. Warning signs for melamine-tainted formula include vomiting, unexplained crying with urination, high blood pressure, swelling, leg pain and unexplained fever. Be safe: Look for the “Made in the USA” on formula labels as these products have been found safe and nutritious.

Prepare a fresh feeding each time one is needed. Each feeding should be prepared in an individual bottle, cooled quickly and stored in the refrigerator. Any opened feeding that has been in the refrigerator for more than 24 hours should be discarded. Refrigerated feedings can be rewarmed under warm, running tap water for no more than 15 minutes. Never use a microwave oven to rewarm feedings as microwaves heat unevenly, and hot spots in the food can scald your baby’s mouth.

Formula-fed infants need to eat every 3-4 hours with an increase in volume each day. Any feeding not eaten within 1-2 hours should be thrown away.

Infant feeding: Nipple choices

When possible, choose silicone rather than rubber nipples as they retain fewer odors and are good for families with latex allergies. They cost a little more but are worth the extra pennies as rubber nipples tend to break down more quickly.

Choose a slow-flow nipple for newborns and progress to faster-flow nipples as baby demands more food. Orthodontic nipples are good choices for nursing babies as they offer mouth positioning more similar to the breast.

Clean feeding

Sterilize all equipment used to bottle-feed your baby in boiling water before the first use and in a high-temperature dishwasher or by regular hand-washing, as desired, thereafter. If you’re using well water that’s not chlorinated, sterilize all equipment each time formula is prepared.

Prevent choking

Cradle your baby upright in your arms during feedings. Holding the bottle at a 45-degree angle ensures the nipple of the bottle will be filled with liquid so that baby doesn’t gulp extra air. When bubbles are rising in the bottle, your baby is eating effectively. If your baby is leaking formula from the corners of her mouth, she’s likely getting food too quickly, choose a slower-flowing nipple.

Never prop a bottle for baby, or allow your baby to recline or sleep with a bottle as this increases the risk of choking and ear infections.

Choosing BPA-free bottles

Use only BPA-free bottles because BPA exposure is linked to potential brain, liver and reproductive organ problems. Bottles with the recycling symbol #7 contain mixed plastics and therefore, BPA.

Preparing Infant Formula

  • Clean and disinfect all equipment and the work area.
  • Wash your hands with soap and water; dry thoroughly with a clean towel.
  • If you’re boiling water, ensure it comes to a rolling boil and cool before mixing with formula.
  • Use only the exact amount of room-temperature or warm water specified on the formula package.
  • Add the exact amount of powdered formula to the water in the bottle using a measuring spoon.
  • Mix thoroughly by gently shaking or swirling the bottle.
  • Immediately cool by holding the bottle under cold running tap water or by placing in a container of cold/ice water.
  • Dry the outside of the bottle with a clean cloth.
  • Before feeding, check the temperature of the feeding by dripping a little of the formula onto the inside of your wrist—it should feel lukewarm, not hot.
  • Feed your baby in an upright position.
  • Discard any feeding that has not been consumed within 1-2 hours.

Source: World Health Organization

Safely Rewarming Formula

  • Warm a cold bottle just before it’s needed
  • Rewarm for no more than 15 minutes
  • Submerge the bottle in warm water until the level of the water covers the formula
  • Occasionally shake or swirl the bottle for even heating
  • Before feeding, swirl the bottle and drip some of the formula onto the inside of your wrist—it should feel lukewarm, not hot
  • Discard any food not eaten within 1-2 hours

Source: World Health Organization

About the authors: Mary E. Hancock, MSN/Ed, RNC-OB, is an assistant professor at the Bon Secours Memorial College of Nursing in Richmond, VA. Jeannette Brown, MSN, RNC-OB,C-EFM, is the nursing coordinator for Virginia Commonwealth University Department of Advanced Reproductive Medicine in Richmond, VA.

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