If you’re bottle feeding your baby, infant formula or expressed breast milk should be the only form of milk your baby gets during the first year of life.  When your baby comes home from the hospital, they will probably take 1.5 – 3 ounces of prepared formula at each feeding.  When the baby is able to empty the bottle, you may begin offering more at each feed in order to satisfy them.

Formula Preparation Guidelines per CDC

  • Clean up before preparation
    • Wash your hands with soap and water.
    • Clean bottles in a dishwasher with hot water and a heated drying cycle, or scrub bottles in hot, soapy water and then sterilize them.
    • Clean work surfaces, such as countertops and sinks.
  • Prepare safely
    • Keep powdered formula lids and scoops clean (be careful about what they touch).
    • Close containers of infant formula or bottled water as soon as possible.
    • Use hot water (158 degrees F/70 degrees C and above) to make formula.
    • Carefully shake, rather than stir formula in the bottle.
    • Cool formula to ensure it is not too hot before feeding your baby by running the prepared, capped bottle under cool water or placing it into an ice bath, taking care to keep the cooling water from getting into the bottle or on the nipple.
    • Before feeding the baby, test the temperature by shaking a few drops on your wrist. 
  • Use up quickly or store safely
    • Use formula within 2 hours of preparation. If the baby does not finish the entire bottle of formula, throw away the unused formula.
    • If you do not plan to use the prepared formula right away, refrigerate it immediately and use it within 24 hours. Refrigeration slows the growth of germs and increase safety.
    • When in doubt, throw it out. If you can’t remember how long you have kept formula in the refrigerator, it is safer to throw it out than to feed it to your baby.
  • Practice proper hygiene
    • Wash your hands carefully with soap and water, especially after using the toilet or changing diapers. Always wash your hands:
      • Before preparing and feeding bottles or foods to your infant
      • Before touching your infant’s mouth
      • Before touching pacifiers or other things that go into your infant’s mouth
    • If soap and water aren’t available, use an alcohol-based hand sanitizer. These alcohol-based products can quickly reduce the number of germs on hands in some situations, but they are not a substitute for washing with soap and water.
    • It is also important to keep all objects that enter infant’s mouths (such as pacifiers and teethers) clean.

Proper Nipple Hole Size

The size of the nipple hole should be large enough to let milk flow freely, one drop at a time.  If the milk doesn’t form separate drops or flows too fast, throw the nipple away.  If the formula flows too slowly, carefully enlarge the nipple hole with a needle or toothpick.  If you use cross-cut nipples, throw them away when the opening becomes too soft.  Usually your baby will indicate if a change is needed by either feeding too slowly or by gagging and sputtering if the nipple flow is too fast.

As you feed your baby, keep the bottle tilted so formula fills the nipple and the baby can’t suck any air through.  Too much swallowed air will give the baby a false sense of fullness.  The baby may also become uncomfortable from gas later.

Propping or Sleeping with the Bottle

Never prop your baby’s bottle or let them feed by themselves.  Not only does it deprive your baby of needed contact with you, but small unattended babies may choke when left with a propped bottle.  Do not allow your baby to sleep with the bottle.  Sleeping with the bottle encourages a habit that will eventually cause cavities and tooth loss.


Burping your baby helps remove air swallowed during feeding.  You can wait until the end of the feeding or you can burp at intervals during the feeding.  You’ll soon learn your baby’s burping needs.  Here are some good methods of burping:

  • Hold your baby so that their head rests on your shoulder, and their chest is against yours. Pat your baby’s back or rub it upward with your hand.
  • Lay your baby face down on your lap. Rub or pat their back.
  • Hold them in a sitting position on your lap, with their side toward you. Support their head and back with one hand, chin and chest with the other. Then gently rock them back and forth as if helping them “take a bow” while patting their back.

Spitting Up

Your baby may spit up small amounts of formula or breast milk.   This is no cause for alarm.  It happens to all babies.  You may be able to reduce the spitting up (also known as reflux) by burping your baby more often or longer during and after feedings.  Also, try feeding smaller volumes more often to see if over-feeding is the cause.  Spitting up occurs because the valve-like muscle which connects the swallowing tube (esophagus) and the stomach is immature.  Therefore, food in your baby’s stomach often comes back up into the throat, mouth or occasionally, even the nose.  Most babies have some form of reflux which will improve with time.  Babies approaching four months old are the most likely to reflux as they are drinking more liquid for their stomach size and body mass than at any other time in their life.  By one year of life, the diet will include more solid foods and the muscle will be much more mature.  These changes will help keep your baby from refluxing as much.

Medical intervention for spitting up may be necessary for the following reasons:  poor weight gain, extreme discomfort or reflux that is green.


Hiccups are a normal part of being a newborn.  Usually they bother us more than they do our babies.  No treatment is necessary and there are no preventative measures that can be taken.  Some babies even hiccup in the womb.


All newborn babies have gas.  This is a normal part of newborn life.  No intervention is necessary.  However, if you would like to try some anecdotally supported therapies you can safely try the following:

  • Simethicone gas drops (Mylicon): Mylicon has not been proven to be any more effective than placebo in studies. However, this medication is safe to use as directed.
  • Frequent burping: You can increase the frequency of burping during your feeding time (for example: burping after every ounce of formula). This may reduce the amount of air you child swallows, thus reducing the amount of gas they release.
  • Brown’s/Avent bottles: Anecdotal evidence supports the use of these bottles although, studies have not confirmed this. Nonetheless, they are safe to use.

Sharing Mealtimes

Mealtime is more than an opportunity to get nutrients into your baby.  It’s a time for closeness and sharing.  Your baby’s meals are as much for their emotional pleasure as well as for their physical well-being, so maintain eye contact with your baby while you feed them.  Comfortably hold them close to you, seating them in your lap with their head resting in the bend of your elbow and slightly raised.  Talk to them softly during the feeding.  Around six months of age, when your child is able to sit up, have them join you at the dinner table in a high chair.  Once your baby is able to sit at the table, eat together as a family and keep scheduled meals and scheduled snacks at the table to prevent roaming and grazing.

Milk Allergy/Formula Intolerance

A true allergy to any food is not common in infants.  Lactose intolerance is also quite rare in full-term babies, but it can occasionally occur in premature infants.  If you are concerned that your child is having problems with formula, you may try switching to a hypoallergenic formula (Nutramigen or Alimentum).  However, in the vast majority of babies this is unnecessary.  As with any other food, it takes time for the digestive system to adjust to formula.  Remember, this is the first food ever to enter your child’s digestive system.  True signs of formula intolerance include blood in the stool, repeated vomiting/reflux, lethargy, extreme fussiness, and poor feeding.  If you are ever concerned about formula intolerance, please consult with us in the office.