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Bottle Feeding
Bottle Feeding FAQ
by Tracey McElmeel

Bottles and Nipples

What kind of bottle should I use?

Choosing a bottle for baby can often times be as confusing as choosing a stroller. What kind of bottle should I use? Which nipple is right for my baby? And what the heck is the bottle flow rate? But more times than not, no matter how much research you have done into the best bottle types and brands, the final choice is baby's. Some babies will only take one type of nipple, some bottles may cause gas, and some babies can only handle one flow rate.

There are many different kinds of bottles, including wide-mouth, disposable, and angled bottles. To start out, you will probably need at least six bottles, that way you don't have to wash the bottle after every feeding. Wide-mouth bottles make formula preparation easiest, especially when using powdered formula. The opening is larger than in other bottles, so there is less chance of the formula spilling over the sides. Often a bonus for those 2 a.m. feedings! Wide-mouth bottles are also easier to clean. Disposable bottles use a new liner for each feeding. Place the liner in the bottle, pour the formula in, screw the cap on, and go. Once the bottle is finished, simply throw out the liner and rinse the nipple out. The pros of using disposable bottles is that clean-up is much easier, each new liner is sterile, and all of the air can be pushed out of the bottle, helping babies to swallow less air, which, in turn, can cause less gas. The only drawback of disposables is that you always have to buy new liners, which can become expensive. Another bottle option is angled bottles. These bottles have a neck which is set at an angle, allowing more formula to flow into the nipple, and less air, again, helping prevent gas.

What are the different kinds of nipples?

Another consideration when preparing to bottle feed is choosing a nipple type. Bottle nipples are made out of either latex or silicone. Silicone nipples are smoother than latex and are clear, where as latex nipples are usually light brown. It is usually a matter of baby's preference which to use. There are also many different nipple shapes, including orthodontic nipples, which fit farther back in the baby's mouth and allowing a more natural sucking action, but require proper positioning in the mouth. Wide-based nipples are usually a better choice for breastfed babies as they mimic the shape of the breast. There are also rounded or flattop nipples. No matter what type of nipple you choose, you will need to have extras on hand in order to replace nipples as they wear out.

What the heck is a flow rate?

Some nipples come with different flow rates. There are slower flow nipples for newborns, and as they grow older, there are nipples with medium and fast flow rates. To check the rate of the flow, simply tip the bottle upside down and see how fast the liquid comes out. If the flow rate is too fast, baby will choke on the formula and spit it out. Some babies will need faster flow rates as they get older and some babies will simply stay with the same rate as long as they are taking the bottle.

Preparing Bottles

How do I sterilize a bottle?

One of the most important parts of bottle feeding is sterilization. Before the initial use, all parts of the bottle, including the bottle, nipple, cap, and nipple ring, should be sterilized. There are different ways to do this. The most popular way to sterilize bottles is to bring a pot of water to a boil and drop all of the pieces in, leaving them to boil for about ten minutes. There are also special sterilizing units, which can be used in the microwave or to steam clean bottles.

An option that is more popular overseas is cold sterilization. In cold sterilization, all bottle parts go into a unit that holds a special sterilization liquid. Sometimes tablets are used; sometimes the liquid itself is chosen. The bottles are completely submerged, and can be left in the unit until they are needed. Generally, the process takes 30 minutes, with the liquid needing to be changed every 24 hours or so. The bottles must be rinsed thoroughly with cool, boiled water before they are assembled in order to remove the sterilization chemical.

What kind of water should I use?

Another consideration when preparing bottles is choosing the right kind of water. The most obvious choices are tap, well, boiled, or bottled water.

If you have well water, it is very important to have it tested BEFORE using it to prepare your baby's formula. Some conditions in well water, such as high mineral levels (sodium or nitrates), can be very harmful to your child. Call your local health department to find out how to test your well water or to locate a company that will do it for you.

You may also choose to use regular tap water, but it should also be tested first. Many communities have inferior water sources and some household pipes may be contaminated with dangerous residue. You can contact your city's water company for a detailed report on the condition of the town's water supply.

When using tap water, it is important to remember to use water from the cold faucet and to let the water run for about two minutes to reduce the chances of lead pollution.

Never use water from a water softening system, as it will contain high levels of sodium. If possible, isolate a line and bypass the system all together.

Mineral waters are also very dangerous to your baby as they often contain high levels of mineral salts and bacteria. If you must use mineral water, make sure it is non-carbonated, low in salts, and boiled before use.

Another popular option is to use bottled water, either from a home water cooler or jugs bought from the grocery store. These waters have been treated to remove dangerous minerals and bacteria and are safe to use in formula preparation. Some companies have special "nursery water", which often cost more than regular bottled water. There is no difference between nursery water and the other bottled waters, except for a higher price!

Why do I need to warm my baby's bottle, and what is the best way to do it?

Many new parents believe the common misconception that a baby's bottle should always be heated. In actuality, there is no medical reason to heat bottles before serving them. Some infants may prefer warm bottles, but most will happily accept a lukewarm or cold bottle. Try starting your baby off with a cold bottle, straight from the refrigerator; if he takes it, you have saved yourself a lot of time! You will appreciate this for those late night feedings!

If you do choose to warm your bottles, always remember to shake the bottle thoroughly after it has been warmed and test a few drops of the formula/breast milk on your wrist before giving it to baby. This will eliminate hot spots and ensure the temperature is just right.

There are specially made commercial bottle warmers on the market, which makes heating the bottles much easier. Simply place the bottle in the warmer, wait the suggested amount of time, shake, test the liquid, and serve. Some commercially made warmers will even plug into your car's cigarette lighter, making feeding on the go even easier. The safest and fastest way to heat a bottle is to hold it under a steady stream of hot water from the faucet.

Some women choose to warm bottles in the microwave, but this is a very dangerous option. It is a quick way to warm bottles, but it is also very unsafe. Using a microwave causes bottles to heat unevenly, leading to hot spots, which can scald your baby, or may even cause the bottle to explode, leading to serious burns. If you are using breast milk, no amount of shaking will distribute the heat evenly. The fat particles in breast milk can reach excessive temperatures, and no matter how cool the bottle feels, there may be dangerously hot pockets of liquid. There is even some speculation that heating bottles in the microwave may reduce the nutritional value of formula or breast milk, as the microwaving process breaks down many of the nutrients. Since a baby relies on formula or breast milk as its only source of nutrition for the first few months of life, it is risky to play with nutritional values.


What kind of formula should I use?

There are many different formula choices on the market today, and often times it can be confusing to try and pick the right one for your child. Usually you will be sent home from the hospital with some formula samples after your baby is born. Although it is not of major importance to stick with the same brand your baby was being fed while in the hospital, some babies may have problems switching between brands, as each one is made slightly different. If you didn't receive any formula, the easiest way to choose one is to talk to the pediatrician, who will recommend which formula is most suitable for your baby. Always inform your pediatrician of any problems your baby is having with a current formula, so they can assess the situation and determine if a switch needs to be made. Each baby is different, so if you find a formula that works, stick with it!

There are three different types of formula. The first, and most common, is cow's milk-based formula, which is available with or without added iron. There is some controversy over babies receiving formula without added iron, but be sure to contact your doctor about which is best.

The second type of formula is soy-based. Soy-based formula is recommended for babies that have problems digesting lactose, which is the main carbohydrate in cow's milk formula. Diarrhea, gas, and bloating are common signs of lactose intolerance. Many babies will outgrow the intolerance within a few months, and may be switched back to cow's milk formula over time.

There are also several specialized formulas available, which are used to treat special problems or diseases. If your infant needs a specialized formula, your pediatrician will instruct you which is the best for your child. Never use a specialized formula without your pediatrician's consent.

Which is best, ready-to-feed, concentrate, or powdered?

There are three different forms of formula available: ready-to-feed, concentrate, and powdered. Each has its own advantages and disadvantages, and it is up to the parents to decide which they prefer.

Ready-to-feed is the most convenient formula to use. It is already prepared in the can, simply open it up, pour it into your own container, and pour into bottles as needed, but it must be used within twenty-four hours after it is opened. The main drawback is that this type of formula is the most expensive. If you are on a budget, it may not be the best choice, but if you are traveling and may not have access to a safe water supply, it can be very handy.

Concentrate falls in the middle for both convenience and price. When using concentrate you will need to add water to the formula. Always consult the can for proper mixing instructions.

Powdered formula is the most inexpensive, but also takes the most work to mix. If your are using formula to supplement breast feeding, powdered formula is the best choice, as you can make up bottles only as you need them and not waste any left over formula. You must add the precise amount of powder to the proper amount of liquid. This can be tough to focus on at those 2 am feedings, but in time it will be as natural as changing a diaper! Again, always read the instructions for proper preparation, as it is very dangerous to dilute the formula or make it too strong.

Spit Up

Why does my baby spit up?

Some babies, no matter what kind of bottle you use, no matter which formula you feed, are just prone to spit up. Almost all babies will outgrow this before their first birthday.

There are a few things you can do to help prevent or reduce spitting up.

  1. Try to make feeding times as quiet and relaxed as possible. The fewer interruptions, the less chance your baby will gulp more air. Burp your baby every 2 to 3 ounces if bottle feeding, every 3 to 5 minutes if breastfeeding.

  2. Never feed a baby while s/he is lying down, and always try and keep baby upright immediately after feedings for at least 20 minutes, either in your arms or in an infant seat.

  3. Never jostle baby around immediately after a feeding. This may cause their tiny stomachs to revolt, and you to be wearing a fountain of baby puke.

  4. Try and feed your baby s/he becomes frantically hungry - the more s/he cries, the more air they will swallow, causing a pocket of gas under the formula or breast milk, which will eventually come spewing out.

  5. Keep the bottle nipple filled with liquid during the entire feeding - this also cuts down on air consumption.

  6. Don't overfeed your baby. If s/he doesn't finish a bottle, avoid the temptation to urge them to finish. They will know when they're full and if you overfeed, the extra liquid will just come back up.

  7. It may also be helpful to try and burp your baby before feeding the bottle. This will eliminate any air pockets in the tummy and may reduce the spit-ups.

  8. When all else fails, if your baby is just a spitter, always have a burp cloth (or even a towel) nearby to clean up the messes. Keep a bib on your baby at all times to protect those cute outfits, and even place a blanket down under the baby to protect your carpets. Try and clean up any spit-up as soon as possible to avoid staining.

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