 Bottle Feeding
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| Michael Shannon, MD, MPH |
In this interview, Michael Shannon, MD, MPH, a pharmacologist/toxicologist and chair of Children's Division of Emergency Medicine, gives advice on the safety of plastic baby bottles.
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Once the decision is made to provide bottle-feedings, completely or supplementary, you need to decide what to feed. It is advisable to discuss feeding selection with your pediatrician. If you are breastfeeding and plan on initiating bottle feeds, discuss with your lactation consultant and refer to "Information on introducing bottle feedings to a breastfeeding infant."
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Breast Milk: The AAP recommends breast milk as the preferred feeding for infants. There is a demonstrated lower rate of infectious illness in breast milk fed babies. Breast milk can be pumped and stored for later use as bottle feeding. This provides an opportunity for father and other family members to be involved in feeding time.
Refrigerated breast milk should be used within 48 hours after pumping or be frozen. Frozen breast milk should be used within three months. Once breast milk is thawed, it should be used within 24 hours and connot be re-frozen.
Infants exclusively or primarily on breast milk require supplementation with a multivitamin containing at least 200 IU of Vitamin D. Flouride is sometimes needed after 6 months of age if the water supply does not have enough flouride. It is recommended you discuss supplementation with your pediatrician prior to initiating.
Infant formulas: Infant formulas are modeled after breast milk. THey contain adequate amounts of protein, calories, fat and minerals for growth; however, formula does not contain the immune factors that are in breast milk. Infants taking adequate amounts of iron-fortified formula typically do not need vitamin and mineral supplementation. Fluoride is sometimes needed after 6 months of age if the water supply does not have enough fluoride. It is recommended you discuss supplementation with your pediatrition prior to initiating.
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Cow's Milk-Based Formulas: Frequently referred to as standard infant formula, there are many products of this kind available on the market, such as, Enfamil Lipil with Iron, Similac Advance with Iron, Good Start Supreme with Iron. The composition of these formulas is modeled after breast milk with cow's milk as the protein source and lactose as the carbohydrate source. The terms "Lipil," "Advance," and "Supreme" were added to indicate the addition of DHA (Docosahexaenoic Acid) and ARA (Arachadonic Acid), polyunsaturated fatty acids thought to aid in brain and eye development.
The AAP recommends all infants receive iron-fortified formula. Iron is an important mineral for growth and development. A lack of iron in the diet can cause iron deficiency anemia. Studies have failed to show a connection between iron fortification and constipation.
You will find these products available in powder, liquid concentrate and ready to feed.
Other formulas: There are many formulas available for your baby's special medical needs. Many of these products are more expensive (with the exception of soy formulas). It is recommended you consult your pediatrician before changing your baby's formula. Here is a list of other formula products available (not comprehensive):
Soy milk-based formulas, such as Prosobee Lipil and Isomil Advance, contain soy protein and are lactose free.
Protein hydrolysate formulas, such as; Alimentum Advance, Nutramigen Lipil and Prestimil, contain cow's milk protein in a more broken down form that may help your child tolerate the formula. Additionally, these formulas are lactose free. You will find these products available in powder, liquid concentrate and ready to feed form. Pregestimil is only available in powder form.
Elemental formulas, such as; Neocate and Elecare, are cow and soy protein free formulas with completely broken down protein (free amino acids). These formulas are commonly used for severe allergies and are lactose free. Many of these products are only available in powder form.
Premature infant formulas, such as, Premature Enfamil Lipil and Similac Special Care Advance, are products used during hospitalization. They are modified to contain more protein, vitamins and minerals to met the special nutritional eneds and digestive capabilities of the premature infant. The protein source is cow's milk and there is a modified amount og carbohydrate as lactose and modified fat as medium chain triglycerides.
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It is recommended a baby exclusively breastfeed for the first three to four weeks before a bottle is introduced. This allows the mother's body to fully establish milk production prior to separation from the baby and helps avoid nipple confusion between the breast and artificial nipple. A variety of bottle nipples are available, many designed to mimic the breastfeeding experience. Some tend to be more compatible with breastfeeding than others, and some babies prefer one type over another.
Bottle feeding is initiated for a variety of reasons. Often, a bottle is introduced to provide adequate nutrition to a baby during the mother's absence. Breask milk can be expressed for bottle feedings or formula may be substituted. Some babies will not take a bottle from their mother, as they are accustomed to breastfeeding. Bottle-feeding by the father or another caregiver may be necessary for successful introduction of bottle-feeding. Lactation consultants can provide assistance with this transition. This will also help the baby adjust to someone other than the mother providing the feedings.
The timing of bottle introduction depends on when a legthy separation of mother and baby is anticipated (i.e. end of maternity leave). It is recommended to provide one bottle-feeding daily for 1-2 weeks before anticipated separation of mother and baby. Scheduling a bottle feeding during the usual time mother and baby will be separated may help the baby transition and form a new routine. Older babies often can take supplemental feeds with a cup or sippy-type cup.
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Introducing a bottle prior to returning to work
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How you introduce the bottle in preparation for returning to work may depend on the length of your maternity leave. If you must return to work within four to eight weeks of giving birth, start by adding a bottle of your expressed milk about one or two weeks beforehand. Choose a feeding when you may normally be away from your baby and only provide a bottle to him/her during that time. This may help the baby adapt more easily to the change, as it will have become a part of his/her regular routine. However, you may want to limit the amount in the bottle, so the baby will be ready to breastfeed within two to three hours.
For a longer maternity leave, you may want to introduce a bottle with your milk by eight to 10 weeks, but there is no need to offer it on a daily basis or at a time when you will be away at work. That can wait until one or two weeks before your return to work.
If you do not have to return to work until the second part of your baby's first year, you probably can avoid introducing a bottle altogether. Older babies often do well when drinking directly from a cup or a sipper-type cup.
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