Integrative Advice on Infant Formula Feeding: Tips and Precautions
My name is Mary, and I own Rosula Doula. I am not a medical professional. I am a Doula and Newborn Care Specialist.
My advice is as integrative and judgment-free as possible while maintaining a standard practice of educating my community about being as healthy as possible with their chosen options.
Always consult your pediatrician and physician. At the end of the day, what I say is only considered a suggestion.
I am passionate about baby and mama and family bonding and development. In the end, a fed baby is happy and healthy.
Today’s blog explains why families may choose infant formula and how to prepare infant formula.
There are many reasons why people choose to feed their babies formula. We must not judge their motivations.
Breastfeeding is nutritionally the gold standard. Breast milk includes essential nutrients and antibodies necessary for infant development, including genetic changes as the baby ages. It also assists in parent-baby bonding and health.
Infant formula imitates breast milk to an extent but does not include bioactive substances to aid infant immunity. Mechanically, most infant formulas have many of the necessary nutritional components to thrive.
Some pediatricians need to be made aware of the nutritional components of formulas. It is up to the parents to find a formula-informed provider and inform themselves of each formula’s different dietary components and regulations based on their infant’s needs, whether by the Federal Drug Administration (FDA) or the European Commission (EC). Typical formula side effects are food allergies, contaminated formula, or improper formula.
WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children created by the United States Government. WIC provides parents with a stipend for available formulas. However, if a parent requests by necessity or a doctor prescribes the need for a particular formula, a family can obtain access to specific formulas via a voucher.
The reasons parents may choose to feed their infant formula can include:
Any caregiver could feed the baby, versus only the breastfeeding parent, as someone else could assist if they are at work or resting.
If parents have multiple babies, formula feeding could be mentally or physically more manageable for the parents.
Research suggests infants who consume formula sleep through the night sooner than breastfed infants, meaning more sleep for the parents and the baby.
5% of women experience an inefficient milk supply
Babies have different types of allergies:
An allergy to breast milk
An allergy to something within the diet of the parent’s breast milk
7% of babies have Cow’s Milk Protein Allergy (CMPA)
A baby has:
Acid Reflux and or
Gastroesophageal Reflux Disease (GERD) and or
Gastritis from the severity of the Acid Reflux
The baby’s diet must be regulated calorically due to developmental concerns or weight gain. Therefore, infant formula is added to breast milk as the infant’s pediatrician prescribes.
Poor oral dysfunction / oral coordination without the use of formula thickener for feeding
The mother cannot access via distance or afford access to a Lactation Consultant (LC) or an International Board Certified Lactation Consultant (IBCLC) who assists with latching a baby to the breast.
A baby is fed via a feeding tube and requires nutrition this way. There are three types of feeding tubes used on infants. I will not discuss this. In some cases, only specific formulas are safe for this type of feeding. A doctor will prescribe and discuss this with that baby’s family.
The baby has a Failure To Thrive (FTT), a vague term that could resemble one of the above suggestions, multiple above suggestions, none of the suggestions, or something unknown.
Now, for preparing any bottle, and, in this case, properly preparing formula:
Wash your hands thoroughly for at least 20 seconds.
When purchasing a bottle, thoroughly wash the bottles and all parts, and then sterilize before first use. The options for sterilizing are in a pot of boiling water for 5 minutes, in a sterilizing microwaveable bag or sterilizing container, or in a sterilizing machine. Screw tops of bottles, after the first sterilization, are to be washed, as it warps the plastic. Once the plastic is deformed, it doesn’t screw back on the bottle, leading to potential messes!
You’ll want to repeat this process after each use of the bottle. Formula is not sterile and seeps into the pores of the bottle and its parts. It is necessary to wash the bottles promptly and sanitize them soon after and always before subsequent use.
Once the formula has touched a baby’s lips, the baby’s oral bacteria create pathogens that multiply within the bottle. These pathogens can cause the infant to get sick. Whether using a formula with or without thickener, using the bottle’s contents within 1 hour is pertinent.
Have a clean surface prepared or a clean towel or paper towel set down on a surface while you prepare the bottle.
The Centers for Disease Control (CDC) says tap water is okay for formula. The CDC is about 20 years behind in guidelines and expectations. The US Environmental Protection Agency (USEPA) is continuously working to update and manage expectations of our waterways. Read the Environmental Working Group’s (EWG’s) website database to learn more about the water in your area.
Our water systems contain lead, birth control hormones, fluoride, fentanyl, and feces. Yes, the government “filtrates” our water but does not filter all these components.
I will order the best ways to source water for the formula:
A Reverse Osmosis (RO) system is known to remove many of the contaminants I mentioned. However, not all RO brand systems are the same, and an RO system is best used in practice as it removes most of what I mentioned above. The RO system is an expensive choice. Water softeners are not the same as RO systems.
Distilled water is the next best thing you can buy on the shelf if you cannot afford a RO system.
RO Systems and Distilled water remove trace minerals from water. Do not add trace minerals back to the water used for an infant. Adding trace minerals to the baby’s water can cause a mineral overdose. The formula will include enough minerals for a baby to develop.
The next best option is certain brands of bottled water. I can not tell you what brands these are for liability reasons. I encourage parents and medical professionals to determine which is best.
The next best system is to buy a basic pitcher with a filtration system and then boil the tap water it filtered.
Next is general bottled water. Remember, bottled water is taken from one area of the world or the United States and “filtered” and put in a bottle. It still may have many of the contaminants I mentioned at a trace level.
Water straight from the tap, filtered through a pitcher filter, or from a bottle of water must be boiled for at least 5 minutes at 100°C or 212°F to prepare for the formula.
After sterilizing the water, it can be kept in a glass or stainless steel container, with no lead on the outside of the glass or rusted metal lids, for future use. Make sure the lid has a vent on top, like poked holes or a sliding release, so that the air can ‘breathe,’ as any leftover chemicals or flora breaking down and interacting with each other can be released through evaporation.
Ensure the bottle parts fit when prepping the bottle during the water cooling. Each bottle has its ventilation system. For example, Philips’s AVENT ventilation system requires the silicon nipple to align with the notch within the screw top to release air properly.
In regards to formula choice, a parent, in the end, will make the best decision for their baby. Every baby has different nutritional needs and different allergies. Therefore, it is essential to look into the formula ingredients, ensure the baby’s needs are met, and avoid formulas that contain the baby’s allergens. If you are concerned about allergies, find an allergist near you that works with infants and does allergen-specific immunoglobulin E, or IgE, testing before the baby is placed on acid-reflux medication or attempting multiple formulas due to unknown “complications” that cannot be resolved from only properly making a bottle. Attempting to try multiple formulas on an infant in a short period can cause long-term harm, such as new allergies.
Cronobacter is an everyday bacteria found in infant formula, powdered milk, and breast pump equipment. It is the reason for the Infant Formula Shortage in 2022. This bacteria causes severe infections in infants, especially those “younger than two months of age or born prematurely.” To remove the potentiality of Cronobacter within the formula, follow the next steps:
Let the sterilized water we discussed cool to 158°F. It must be at this temperature to remove Cronobacter. Infant formula is not sterile. However, read the instructions on the formula canister. The temperature may not specify that it be heated at 158°F, so double-check. If otherwise noted at a significantly lower temperature, contact the product’s manufacturer. (The following instructions are usually universal but should not be considered a replacement for the instructions of the product or a medical professional.)
The formula canister should state how much water is needed for how many scoops. Pour the amount of water into the bottle first, based on the amount of scoops suggested by the manufacturer. When pouring the water, I recommend pouring water based on milliliters (mL) instead of ounces (oz) because the standard measurement for ounces between the United States and Europe is slightly different, which can dilute the concentration of the formula and measurement when recording the baby’s total liquid intake.
Measure the formula with the provided measuring scoop. Do not pack the formula into the scoop. Level the formula off at the top of the scoop. You can do this with a sterilized knife, eyeball it with good eyesight, or use the side of the canister to dust off the scoop.
The purpose of measuring formula is to ensure that a baby receives the correct caloric intake. If the scoop of the formula is mismeasured, either by insufficient formula or being packed too full, the caloric nutrients will be calculated inappropriately. In that case, the baby could receive too few calories or too many. An inaccurate amount of formula can cause many medical complications I can not even begin to list.
One will want to measure out slightly more than the baby needs because this will ensure that there is no need to “shake” the last of the formula into the baby’s mouth. They will also be less likely to swallow air, unintentionally making a gassy baby.
The formula can then be placed into the recommended water temperature. After that, let the formula cool to about 95° to 110°, depending on the baby’s drinking preference. 37.11°C or 98.8°F is about the temperature of breast milk coming from the mother’s body. 99.8°F is the general temperature a baby will drink milk or formula; however, some prefer it slightly warmer, especially if they struggle with acid reflux.
The coffee ordered at a local coffee shop is generally about 54.44°C or 130°F. Do not feed at this temperature. I’m giving a reference for what temperature some adults drink their coffee.
While the formula cools to a lower temperature, place the nipple inside the screw top appropriately, screw the top on tightly, place the lid on, shake the bottle up and down to mix the formula, or use a sterilized milk frother to mix the bottle’s contents.
Formula thickener thickens breastmilk and formula to aid a baby’s digestion, helps with GERD or acid reflux, or assists with oral coordination. Please read the label of the formula thickener for its instructions. The following instructions are specifically for GelMix. Once the formula temperature decreases to 43.33°C or 110°F, GelMix can be mixed in. It must sit in the formula for at least five minutes to ensure it thickens correctly. Wait time can be up to ten minutes for a larger quantity of liquid. Adding a formula thickener will increase the volume of the formula offered to the baby. After the wait time, the formula’s temperature may no longer be warm enough for the baby’s preference, and the bottle may need to be reheated. If using GelMix, sometimes a larger nipple size might be necessary to distribute the liquid to feed the baby without struggle and ease their oral coordination.
Never microwave breastmilk or formula, and never reheat via the microwave breastmilk or formula. Use of the microwave can create hotspots inside the bottle, causing harm to the infant. One can microwave water in a microwave-safe mug and then heat a bottle in warm water.
Sometimes, infants do not like the way their formula tastes. A way to assist this is by adding alcohol-free vanilla to the mixture. I use a syringe and put one drop for every 10 mL of liquid in a bottle. Over time, I gradually decrease the amount of alcohol-free vanilla I add until I am adding none.
Babies can also be quite gassy. Sometimes, it is helpful to add gas relief drops to their bottles. Please consult a pediatrician if a baby may benefit from this practice.
Now you’re ready to feed a baby!
Please message me for a follow-up if you have any questions.
I thank Gregory Ripps, Summer Hartman, and Allen Carrillo for proofreading my first blog post.
