Bottle Feeding

. . . but a baby can revel

in bottle-feeding too.

We have no real alternative to the breast-fed baby's colostrum, so while the bottle-fed baby may start life with one or two drinks of sugared water, formula will be offered by the second day. This is much sooner than a breast-fed baby would find milk, so your baby may take very little. The water content is needed much more than the food content, so don't worry.

If your baby does take all the milk offered, weight gain may start from birth instead of after a few day's weight loss. Although early weight loss often worries parents, don't be too enthusiastic about every ounce your baby gains; bottle-fed babies can get too fat.                     .

Choosing a Formula

Cow's milk is ideal for calves but it is not the natural food for babies. It contains too little sugar and the wrong kind of fat. Its protein makes indigestibly solid curds in the baby's stomach and it contains more minerals - especially sodium - than human milk. Babies under six months should not be fed on any kind of unmodified cow's milk or on goat's milk either, so ignore liquid, dried or evaporated milk from dairies, supermarkets or health food stores. Bottle-fed babies need a breast milk substitute, or formula. Modern formulas are based on cow's milk but are more or less extensively adapted to bring the made-up food as close as possible to breast milk.

Even the recommended formulas do vary, though. Most now include the right amount of all the necessary vitamins. They are available with or without supplementary iron. Make your choice in consultation with your doctor. And seek your doctor's advice about whether to give your baby the normally recommended multivitamin drops in addition to the particular formula you have chosen.

Formulas vary in their convenience as well as their constituents. In powdered form most mix easily when they are simply shaken up in the bottle with the required amount of cooled boiled water. Some of the formulas are available as liquid concentrate, rather like ordinary evaporated milk. The 8oz (225g) or 32oz (900g) cans are heavy to carry and must be refrigerated after opening but the formula is easy to measure and mix in cans. The milk can be kept in the opened can provided it is refrigerated, but any that is left after 24 hours should be thrown away.

If neither the weight of your shopping nor storage-space is a problem, some formulas are available in convenient ready-to-drink form. And for the ultimate in labor-saving, though at a considerable cost, you can buy ready-to-drink formula sealed into pre-sterilized disposable bottles.                                

Preparing Bottle Feedings

You cannot safely take a happy-go-lucky approach to preparing bottles, especially while your baby is very young. Hygiene is important if he is to stay well, and correct preparation of the formula is important to proper nourishment.  

Hygiene 

There are bacteria everywhere. We all carry them on our hands and our clothes. We breathe them, eat them and excrete them. Most of them are harmless. Very few types will make us ill unless we take in such a large number all at one time that our bodies' defenses are overwhelmed.

A new baby, especially one who is not breast-fed, has few defenses against common germs. It takes time for him to build up immunity to them. In an ordinarily clean home, he will cope with the germs that he sucks off his hands or breathes in the living room. But when he is feeding it is different. Milk, especially milk which is around room temperature, is an ideal breeding ground for germs. So while he might pick up a few off his own fingers and deal with them perfectly well, he will pick up an enormous, and possibly overwhelming number from a bottle which has been left standing around in a warm room. Gastroenteritis is still one of the most common reasons for young babies being admitted to the hospital. To keep the baby's milk as free from bacteria as possible:     

Wash your hands

before handling the milk or equipment, especially after using the lavatory or handling pets or their food. If you use liquid concentrate, keep a special can-opener for those cans and sterilize the top with boiling water before you puncture it.   

Use a sterile formula 

and keep the packet closed or the can tightly covered and refrigerated once it has been opened.   

Sterilize everything you use in measuring, mixing or storing

the made-up milk. That means measuring spoons, mixing jars and the water in the food itself. 

Sterilize bottles, nipples and nipple covers.  

Provided that you put a sterile nipple cover over the sterilized nipple on your ready-filled bottle, that nipple will still be sterile and safe when you take the cover off to feed the baby.

Bacteria which escape your precautions (by landing on the sterile nipple as you put it on the bottle, for example) cannot multiply dangerously while the milk is boiling hot or while it is icy cold. It is the in-between temperatures that help them to flourish. To minimize the chances of bacteria breeding:

Cool the made-up milk quickly,    

preferably by putting it in the refrigerator while it is still hot.

Keep it cold until the baby wants it.   

Don't put a bottle to warm in advance of him waking up, or keep it warm for him if he drops off to sleep for more than a few minutes in mid-feeding. Never put warm milk in a thermos or electric bottle warmer.

Throw away any milk the baby leaves.    

Don't try to save that half bottle for next time and don't pour the now unsterile remains back into your jar of sterilized formula in the refrigerator.

Making Up the Formula

When you combine milk powder or liquid concentrate with boiled water, you are constructing food and most of your baby's drink. If you do it in exactly the proportions the manufacturer suggests in the mixing instructions, you will end up with a food that is as close to the composition of breast milk as it is possible to get with that particular formula. The baby will get the right amount of nourishment and the right amount of water.

Research workers have found that a great many bottles are not made up accurately. It is largely this inaccuracy which makes bottle-feeding unsatisfactory for many babies. Follow the manufacturer's instructions exactly. Making a bottle is not like preparing instant coffee. You cannot make it better by putting in just a little extra powder, or more thirst quenching by adding extra water. If you add too much powder, the milk will be too strong. The baby will get too much protein, too much fat, too many minerals, and not enough water. He will get fat because you are giving him too many calories, and thirsty because you are giving him too much salt. Because he is thirsty, he will cry, and because he cries you will give him another bottle. If that bottle is too strong, too, he will be even more thirsty. So it will go on. The result can be a baby who cries a lot, does not seem terribly well or happy, puts on a lot of weight, and seems to need a lot of feeding.

Don't be afraid to offer extra drinks of plain, boiled water, but don't add anything to make formula "nicer" or "more satisfying."

Never guess at quantities.    

Measure milk powder accurately by filling the scoop provided and slicing off the surplus at scoop level with a knife. Wiping the surplus off on the edge of the can or smoothing it off with a spoon will not be accurate; you will almost certainly end up with a somewhat packed or heaped scoop. Shaking off the surplus may leave you with either too much or too little powder.

Measure liquid concentrate accurately by pouring it either directly into the bottle or into a marked-off measuring cup and then holding it up to your eye level to read off the marked ounces. If you check the level with your eye above it, you will think there is less milk than there really is. 

Measure the water accurately by boiling it (to sterilize it) first, and pouring it into your bottle or measuring cup when it has cooled. If you measure the water first and then boil it, some of it will be lost in evaporation.

If you really do make up your baby's bottles exactly as the manufacturer recommends, and as long as you resist the temptation to add a spoonful of cereal in the vain hope of a better night, you can treat the resulting milk exactly as if it was breast milk. The baby can have as much as he eagerly drinks, as often as he is hungry, and leave what he does not want. You don't need to carry your scientific accuracy in making the milk on into feeding it!   

Supply and Demand for the Bottle Fed Baby   

How much and how often should bottle-fed babies be fed? They do best if they are treated exactly as if they were breast-fed. Milk should be offered whenever the baby seems to be hungry and the feeding should only be stopped when eager sucking ceases. Don't try to push him to take more than he really wants, though. If he were breast-fed, you could not see how much he'd left. If you stick to these principles in the very early weeks, you will never have to worry about whether to feed "on schedule" because the baby's own schedule will gradually evolve out of his digestive pattern.

A new baby is used to having his food needs continually replenished by transfusion feeding in the womb. Now they must be met by digestion of food from a stomach that starts full and gradually empties. While he gets used to this change he may demand food at irregular and frequent intervals. If he cries only an hour after drinking 3oz (85ml) of formula, you may ask yourself whether he can possibly be hungry again already. The answer is that although his stomach cannot yet be empty, he feels a need to have his food topped off.

If you offer him a bottle whenever he seems hungry, he will only take the amount he needs. If he drinks it all, you can assume he needed it. If he takes a little, the comfort of sucking and of your care will make him feel better. If he drinks none, what have you lost? One bottle of formula.

If you meet these irregular demands willingly, they will stop by themselves in a few weeks. It takes rather longer for a baby to digest formula than breast-milk - around three to four hours. True hunger signals are tied in to the near-completion of the digestive process. Once his digestion is working more maturely and he has got used to this new kind of hunger, he will neither feel nor express distress until he has digested the last meal so his demands will fall into the same pattern as a conventional schedule.

Exactly the same process of maturing and settling into a feeding pattern will take place if you keep your baby to a strict four-hour schedule from the beginning. Offered feedings only at 6am, 10am, 2pm, 6pm and 10pm, he will eventually expect food at these intervals. The difference is that these early weeks will be miserable for you all. The baby will wake and cry. If you do not feed him because it "isn't time" you will try every other method of comforting him, which will be hard work. Because what he really wants is food, and because he will get hungrier and hungrier while you are working away at other methods of comfort, nothing you do will really soothe him. By the end of the session you will be feeling that unhappy mixture of guilt and anger and helpless despair. To crown it all, when the clock does at last say the "right time" and you give him a feeding, he will probably not suck well or take enough milk to keep him happy until the next scheduled meal. All that crying will have tired him and filled his stomach with air. He will probably fall into exhausted sleep after an ounce or two and wake up again in an hour later to repeat the whole performance.

So don't fall into the trap of thinking that if you feed your baby whenever he seems hungry he will get into the habit of demanding food frequently. He does not wake from habit, he wakes from hunger. When he is mature enough to be hungry so often he will not wake up and cry.