Get the Facts on Infant Feedings

Published on in CHOP News

Mother playfully trying to feed young daughter New parents worry about a lot of things, but infant feeding certainly tops the list. Pediatrician Jacquelyn Detweiler, DO, FAAP, offers answers to some of the most frequently asked questions about infant feedings she hears from families at CHOP Primary Care, Kennett Square.

Breast or bottle: which is best for my baby?

The decision to breastfeed or bottle feed with formula is an individual one. Both can support your child’s nutritional needs; and are important opportunities for bonding with your baby. Talk to your baby’s doctor, nurse or lactation consultant for support in making the right decision for your family.

If you choose to breastfeed, moms should continue to take prenatal vitamins, eat a balanced diet, keep hydrated, avoid alcohol and limit caffeine. Mom will breastfeed when the baby is hungry – typically every 2-3 hours during infancy, then lessening in frequency as her milk supply increases and baby can drink more. Breastfeeding boosts the infant’s immunity and can protect infants against infections and prevent chronic conditions like asthma, diabetes and obesity. Breast milk also contains DHA, which promotes healthy brain development and growth. Breast milk may not meet your baby’s vitamin D requirement; speak with your pediatrician regarding a daily vitamin D supplement.

If you choose to bottle feed, it’s important to give your baby iron-fortified baby formula specially designed for them – not milk that comes from a cow, goat, sheep or plant. These forms of milk do not provide the proper ratio of fat, carbohydrates, protein, vitamins and minerals that your baby needs during their critical first year. When choosing infant formula, look for one that is fortified with DHA, which promotes healthy brain development and growth.

All infant formula sold in the U.S. must meet Food and Drug Administration standards. Be sure to follow product directions exactly for mixing and storing. In most cases, public water may be safely used to mix with formula, but well water should be avoided until tested for possible contaminants. If the water quality in your area is unknown, we recommend using bottled water or boiling, then cooling all water used with baby’s formula.

For more early feeding resources, see our Infant Feeding Guide.

Can I use a combination of breast and formula feedings for my child?

Yes! Some breastfeeding moms consider switching to formula when they are ready to return to work. While that is certainly an option, it’s not the only way to keep your baby fed while you are away. A few alternatives:

  • Pump your milk while separated from baby, then allow others to feed it to them.
  • Use a combination of breastmilk and formula to satisfy baby’s nutritional and nurturing needs. When you are together, breastfeed; when apart, use formula or pumped breastmilk.

Combination feeding plans work for many families and mom’s milk supply will soon adapt to whatever method you choose. If you and your baby enjoy breastfeeding, there’s no reason to stop just because you are returning to work.

If breastfeeding is no long possible or enjoyable, it’s fine to change your baby’s feeding plan. Just make sure you discuss it with your baby’s doctor and ease into the new way of feeding. Don’t wait for the last two days of maternity leave to try weaning. It will be painful and disruptive to both you and baby.

My baby is having difficulty feeding, do they have tongue-tie?

This is one of the most common questions new parents ask. If the baby is having any difficulty breastfeeding and doesn’t seem to be latching on properly, parents wonder if their baby has tongue-tie.

If baby is drawing the nipple of the bottle or breast into their mouth, and able to suck and swallow easily, they are generally fine and do not need intervention. If baby is struggling to eat, or mom is experiencing constant pain while nursing, talk to your baby’s doctor. Your infant may need a referral to a specialist for examination and intervention.

How often will my baby need to eat each day?

Newborns up to 4 months old typically require 8 to 12 breastfeeding sessions per day and will consume 16 to 34 ounces during a 24-hour period. Babies should only drink breastmilk or formula during this time.

By 4 months old, most babies have doubled their birth weight. They typically require 4-6 nursing sessions per day and consume 22 to 34 ounces of breastmilk or infant formula. Often, these babies are ready to begin limited solid foods, starting with iron-fortified rice or oat cereal.

At 6 months old, most babies will need 3-5 nursing sessions or 28-34 ounces of formula per day, and an increasing amount of solid food to satisfy their hunger and meet their nutritional and energy needs

Can you overfeed an infant?

Yes, but it is difficult to do. As new parents, you need to pay attention to your baby’s nonverbal cues to learn when they are hungry, and when they’re finished eating. Hunger cues may include crying, fussiness or rooting (looking for milk), while babies may show they are finished by spitting out the nipple/bottle, stopping sucking, turning their head away or falling asleep.

Overfed babies are more likely to spit up and may gain excess weight they don’t need. Healthy babies can self-regulate their food intake. They consume the amount they need to grow and will stop when they are full. Healthy babies will also let you know – generally loudly – when they think it’s time for their next feeding.

How can I tell if I’m not feeding my baby enough?

While formula is easy to measure, milk from the breast is not. Instead, we must rely on nonverbal signs from baby. Are they very fussy, rooting for food or showing signs of distress? This could indicate they are hungry.

One way to measure input is by looking at output. How many wet or soiled diapers does your baby have a day? Newborns should have at least four wet diapers a day; by 2 weeks old, output should increase to at least eight wet diapers, plus 1-3 bowel movements each day. Keep track of your child’s input and output when possible and talk to your baby’s pediatrician if you have concerns.

Weight gain is another factor to watch, but it’s important to know that some babies simply gain weight more slowly, and every baby has their own unique growth pattern. Learn more about infant weight gain.

How long should babies exclusively breastfeed or receive baby formula?

The American Academy of Pediatrics (AAP) recommends that all children be exclusively breastfed or formula fed for the first six months of life and continue feeds until they are at least 1 year old. Some solid foods (such as rice or oat cereal) can be introduced at 4 to 6 months old. We discourage parents from starting solid foods too early because it can lead to abnormal weight gain during infancy and obesity later in life.

What kind of solid foods should my child start first?

The American Academy of Pediatrics (AAP) has a wide variety of recommended menu choices when introducing solid foods to your baby. What’s most important is that your baby receives the iron-rich foods their body needs.

As long as your child’s safety and nutritional requirements remain priorities, don’t be afraid to try different foods to find what pleases your baby’s palate. Focus on introducing a variety of flavors and textures.

Why should I offer the same food to my child multiple times?

Many babies and toddlers need to be exposed to a new food multiple times (10-15 times, over months) before they will try, eat and accept them. They are more likely to eat foods they see their family or peers enjoying.

Jacquelyn Detweiler, DO, FAAP, is an attending physician at CHOP Primary Care in Kennett Square, Pa., and has special expertise in newborn and infant care and feeding.

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