Bottle feeding and formula

Sometimes you already know during pregnancy that you don’t want to breastfeed, sometimes it’s something that develops and sometimes it just doesn’t work out. While there are many different opinions about breastfeeding or bottle-feeding, the important thing is that the baby is fed and loved, and whether that comes through a breast or a bottle is less important. The way you feed your child is a choice you should be respected for and, above all, it should be seen in the light of the fact that you as a parent know what is best for your own family. For those of you who have decided to feed your baby with a bottle, here are some tips.

Bottle feeding

A bottle-fed baby’s food can be either expressed breast milk or formula. Just like when it comes to breastfeeding, mealtime with a bottle is as much about connection as it is about nutrition. That’s why you should think about making it a cosy time with lots of skin contact, because one of the benefits of bottle feeding is that everyone can share in the cosy moments.

Handling and storage of breast milk

For those who pump and bottle-feed breast milk, it is important to know how best to store and handle it so that it does not go off. It is important to have a perfectly clean bottle or container, and to store breast milk in either a fridge or freezer. Freshly pumped breast milk will keep for up to three days in the fridge if the temperature is no more than four degrees. If it is warmer than that, the storage life is reduced. You can also freeze breast milk, for example in a clean ice cube tray or in special bags available for purchase, which will keep it for up to 6 months.

Thaw frozen breast milk by first putting it in the refrigerator for about 8 hours. It is dangerous to heat breast milk in the microwave, so avoid doing that. Instead, heat it in a water bath, or under hot running water, to a maximum of 40 degrees. You can tell if it is the right temperature by pouring a drop on the inside of your wrist. Once you have heated the breast milk, you can’t reuse it, so whatever doesn’t get eaten should be thrown out. Also remember to never mix freshly pumped breast milk with milk from the fridge as bacteria can form in milk when it is at different temperatures.

Tips for bottle feeding

Bottle feeding your baby is often quicker than breastfeeding, but the feeding time itself is equally important in terms of closeness and comfort. That’s why it’s important to try to make it a calm and cozy moment. Here are our top tips on how to get it right:

• Put your child close to you, skin-to-skin in a half-seated position, and make eye contact as you feed. Proximity is important. Then, for safety reasons, you shouldn’t let the baby drink alone even if he or she has acquired the motor skills to do so.
• Sit comfortably, in a quiet environment.
• Wait for your baby’s mouth to open before giving them the bottle. You can stimulate your baby’s rooting reflex by touching their cheek with the teat. Try to get your baby to take a big grasp of the teat as this makes it easier to get the correct sucking technique.
• If your baby turns their head away to look at something else, do not follow with the bottle – let them come back to the bottle.
• If the teat’s hole is too big, the baby will take in a lot of air or too much milk at once, and may get a tummy ache. As your baby grows, you can change the teat – it usually says on the packaging from which age it is recommended. Some babies also benefit from taking a break from eating to burp.
• Angle the bottle just right. The teat itself should be constantly filled with liquid, but the bottle should not be held upside down. This way, you reduce the risk of the baby swallowing air and you don’t give them too much milk at once.
• There are lots of different types of baby bottles, some of which are designed to keep air bubbles out of the milk. It’s a case of trial and error as to which model is suitable, but just like with regular dummies, it can be difficult to get your baby to change the teat once they get used to a model.
• If your baby seems to be sucking hard without getting any food, it may be that the hole is too small or the teat is too hard. Sometimes a vacuum may also have formed in the bottle if the lid is screwed on too tightly.
• Bear in mind that the amount your baby eats can vary from one time to the next, so rely on your baby’s sense of fullness rather than assuming they need the same amount each time.
• If your baby falls asleep in the middle of feeding, let them sleep, but never leave them with a bottle to suck on.
• Empty and clean the bottle after each feed. Breast milk or formula left in a used bottle will quickly go bad if kept.

Feeding your baby with formula milk

Perhaps the most common form of bottle feeding is the use of formula milk. It is available in most supermarkets, both pre-mixed and as a powder to mix yourself. Formula is made from cow’s or goat’s milk and is carefully developed and controlled to resemble breast milk, it also contains all the nutrients your baby needs. You can use formula milk until your baby is around a year old. As with breastfeeding, formula should be your baby’s only source of food for the first six months, with the exception of small tastes of solid food from 4 months at the earliest. Then you can start adding some solid food, while keeping the formula as a supplement, and then phase it out at around 1 year of age, or when the baby is ready.

What you need to know about giving formula

As with all food, you need to pay attention to hygiene. While babies are so small, it’s dangerous to think that ‘a bit of dirt never hurt anyone’ – so it’s important to:

• Always wash your hands before mixing the formula.
• Wash and sterilise everything between uses.
• Remember that newborn babies should have ‘freshly prepared’ food; anything left in the bottle risks going off.
• Never add anything to formula milk, other drinks can make babies ill. Always buy certified formula milk and never mix your own formula.
• Never reheat formula milk – pour out any leftovers.

It’s also important that your baby doesn’t get burned by the milk – whether it’s breast milk or formula milk in the bottle, it’s important to check the temperature by pouring some on the inside of your wrist or pouring it onto a spoon and tasting it. The correct temperature should feel lukewarm.

How do I know if my baby is eating enough?

It’s hard to know how much formula to give. Generally speaking, you can increase the amount of formula by 10 ml per day per meal for newborns. So: day one = 10 ml each meal, day two = 20 ml each time, day three = 30 ml, etc. This only applies to the first few days – after that, your baby will begin to self-regulate. If you want to stop breastfeeding and start using formula, it can be tricky in a different way – there is usually a number on the packaging, but it can’t take into account everything that affects hunger. The time of day, how long it has been since the baby ate, growth periods or other factors have a huge impact. Try to follow your baby’s appetite and signals rather than focusing on what the packaging says or how much they usually eat. Your baby’s weight will be monitored by a healthcare professional to make sure it follows its curve. You can also check the amount of food your baby is getting by making sure your baby is peeing properly, about six full nappies should be changed per day. When your baby is very small, it’s not always easy to tell if a nappy is really full, but if the nappy has a wetness indicator, you can see that it changes colour when your baby pees.

On very hot days, be sure to be extra generous with the bottle as small babies don’t have big reserves and can easily become dehydrated. But don’t mix the formula with anything, or dilute it with water – follow the instructions. Illness can also cause problems; for example, if your baby has a stomach bug, they need a lot of fluids but in very small amounts at a time. The same goes for a cold, in which case you usually need to feed more often but in small amounts so that the baby has enough energy.

If your child seems to react to the formula

If you get the feeling that your child has a hypersensitivity or allergy, we recommend that you contact the hospital or a paediatrician’s office for an assessment instead of starting to tinker with different types of formula yourself. If your baby is found to be allergic to cow’s milk protein, a paediatrician can prescribe a formula that’s free from cow’s milk protein. Soy-based infant formula should only be used in consultation with a doctor or nurse.

Combining breastfeeding and bottle feeding

If you want to combine breastfeeding and bottle feeding, it is a good idea to choose a bottle where the teat itself is designed to mimic the nipple as much as possible. That will help your baby to use the same sucking technique for both. If you want to be able to breastfeed and give formula at the same time, it is good to let the baby breastfeed first, and then supplement with formula afterwards. This is because some babies prefer bottle feeding because the milk often flows a little faster, so if you have started with the bottle, the baby may not think it is worth the effort of sucking hard on the breast to get the milk out and may think they are full enough to stop eating. This will lead to reduced milk production , making it difficult to continue combining breastfeeding with formula.

Please note that all information above is based on Swedish recommendations.