New Parents : I Do Not Want to Breast-feed Bottle-feeding your baby (part 1)

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Q: I don't want to breast-feed—can you tell me what to do?
A: If you do not want to breast-feed, you can either bottle-feed your baby expressed breast milk or formula. There are many women who do not breast-feed because they receive a lack of support and find that the advice available is insufficient. However, making an attempt at breast-feeding, even if it's just for one week, will benefit your baby. If you have chosen to bottle-feed you will need to decide on a few things. First, you need to work out which type of formula you want to use. Take some time to look at the many brands on the market and opt for one that you feel will be right for your baby. Ask your midwife or postpartum nurse for advice if you are not sure. You will also need to purchase bottles, nipples, and a sterilizing unit. This can be confusing since there are lots to choose from, so you will need to take some time to find out about the available options and decide which unit will work best for you (see Sterilizing equipment).
Q: Bottle-feeding sounds so complicated. Are there “dos” and “don'ts” to remember?
A: Yes, it is important to bottle-feed safely. Guidelines for safe bottle-feeding include:
  • Always make sure you use a sterilized bottle, cap, and nipple for each feeding.

  • Ideally, make up one feeding at a time and discard any leftover milk at the end of a feeding.

  • Use boiled tepid tap water that has been left to cool for half an hour before making up a feeding.

  • Put the water into the bottle before the formula.

  • Don't pack the formula into the scoop; instead, level it off gently with a knife.

  • Warm the bottle of formula —not in a microwave, but in a bowl of hot water—and test the temperature before giving it to your baby.

  • Avoid swapping scoops from different makes of infant formula because different scoops may be different measurements.

Q: I feel guilty for not breast-feeding—should I?
A: No! The main thing is to ensure that your baby receives the best possible care in life that you are able to provide. If it is not possible for you to breast-feed, then formula feeding is a safe option. However, you need to feel comfortable with your decision and not be swayed by others. You may want to look at the advantages and disadvantages of both breast- and bottle-feeding. That way you'll be sure you've made the right decision for you and your baby without feeling guilty. Once you have made an informed decision, communicate this confidently to family, friends, and your health-care provider.
Q: Is formula as good as breast milk?
A: Breast milk is universally considered the ideal nutrition for your baby, and the American Academy of Pediatrics recommends breast-feeding for the first year of life since it provides all the nutrients a baby needs for the first six months. However, there are a variety of high-quality, nutritional baby formulas available that scientists and medical experts have spent years developing. Most infant formula milks are derived from cow's milk, but are modified to resemble breast milk as closely as possible. If you feel confused, discuss the different brands with your midwife or postpartum nurse.
Q: What exactly is in formula and how similar is this to breast milk?
A: If you read the labels on different brands of formula, there are not many differences. The Food and Drug Administration provides information on the contents and labeling of infant formulas available in the US. Baby milk must provide energy, fat, protein, carbohydrate, vitamins, minerals, and trace elements, and the quantity of each nutrient is specified by law. The proportions of energy supplied by protein, fat, and carbohydrate in infant formulas are similar to those in mature breast milk.
  • The fat content. In infant formulas this is based on blends of dairy or vegetable fats that are chosen partly depending on their levels of unsaturated fat. Omega 3 fats may be added since these are vital nutrients for growing brains and bodies. Formula does not have the fat-digesting enzyme, lipase, which accounts for the unpleasant-smelling stools of formula-fed babies.

  • The protein source. In formula, this is either cow's milk, in the form of casein or whey, or soy (see soy-based formula milk). The amino acid content of formula is equivalent to that of breast milk to meet the needs of the rapidly growing baby.

  • Lactose. This may be included in formula; mature breast milk contains about 7 percent carbohydrate in the form of lactose, which is thought to be important for brain development.

  • Vitamins, minerals, and trace elements. These are added to formulas to meet the nutritional needs of the baby and to comply with legal requirements.

  • Iron. This is vital to your baby's well-being, being essential for healthy blood, growth, and development, and this is added to formula brands.

  • Other components. Infant formula may contain other components that are found naturally in breast milk, such as long-chain polyunsaturated fatty acids (for brain and membrane development), oligosaccharides (to aid digestion and immunity), or nucleotides (to promote healthy growth and development and to help the immune system).

There are some components of breast milk that cannot be replicated in formulas. For example, breast milk contains important antibodies that help protect babies against infection and illness and these are not present in formula. However, probiotics, which are nutrients found in breast milk that strengthen a baby's natural immune system, may be added to some brands of formula.

Q: Is it OK to combine breast-and bottle-feeding?
A: Yes, it is possible to combine breast-feeding with bottles of expressed breast milk or formula, and many women choose to do this rather than stop breast-feeding entirely. You may also decide to do this if you are returning to work.

Feeding from a bottle uses a different technique than feeding from the breast, and your baby may take a little time to get used to it, which can make it quite a struggle to introduce bottles. It may help to warm the nipple and to get someone else to offer the bottle the first time, since your baby may be able to smell your milk if you hold him and will be likely to want to be breast-fed instead. Holding him in a different position, such as propped up against your front and facing away from you, may also help.

Before deciding to introduce the bottle, it's worth considering that breast-feeding does get easier and that there is a lot of extra work involved with bottle-feeding in terms of preparing feedings. Also, as your breast milk is produced on a supply and demand basis, introducing bottles for some feedings will affect your milk production. If you do want to combine the two, talk to your doctor or a lactation consultant about how to manage this so that you can maintain breast-feeding.

Q: Will people treat me like a failure if I can't breast-feed and have to use formula?
A: Many mothers do feel pressure from friends and family to breast-feed their newborns. It is unlikely that you will be treated as a failure, since Western society is very accepting of bottle-feeding and, on the contrary, it is a continual effort to try to promote breast-feeding in our society. Unlike the UK, the US hasn't been successful in banning advertising infant formula for children under six months old on television and in parenting magazines.

Breast-feeding is a worthwhile endeavor for mother and baby but can sometimes be work to establish. If you find that you are struggling to establish breast-feeding, seek help before giving up. However, if you find you simply cannot breast-feed, or you choose not to, you should try not to feel guilty since formula-fed babies grow and develop well. This is your baby and you have your baby's best interests foremost whatever you decide to do.

Q: Which formula should I buy?
A: There are a number of brands that have a very similar nutritional content and you may need to discuss this with your postpartum nurse or pediatrician, when trying to decide which one to use. Sometimes, babies are born prematurely and may need a special formula, or occasionally may react to a particular brand. If your baby was born full-term and is healthy, it usually comes down to personal preference.

Manufacturers modify cow's milk to make formula for human babies by adjusting carbohydrate, protein, and fat levels, and adding vitamins and minerals. There are two main types of formula, which have different ratios of the two proteins in milk: whey and casein. Those that are suitable for babies from birth contain more whey than casein. The ratio of whey to casein in these formulas is similar to that of breast milk, so it is thought to be easier for new babies to digest. Formulas that are marketed for the older baby (known as “follow-up” milk) are casein-dominant and take longer to digest.

Q: Why do some people use soy-based formula and is it safe?
A: Soy-based formula is made from soy beans, which are modified for use in formula with vitamins, minerals, and nutrients. Some parents consider giving a soy-based formula if their baby has an intolerance or sensitivity to cow's milk formula. Soy infant formulas are nutritionally similar to cow's milk-based formulas. The protein used in soy formulas is an extract of the soy bean, which has a high protein content. However you should always seek the advice of a health professional before giving soy-based formula to your baby. The current advice is that soy formulas should not be given automatically to babies with a sensitivity to cow's milk, since there are other types of formula that are suitable for most babies with an allergy or intolerance that may be more favorable than soy. So if you are considering soy milk, make sure you seek pediatric advice first.

The carbohydrates used in soy milk contain glucose syrup, which may damage your baby's teeth over a period of time, so if you are using soy formula, make sure you take your baby to the dentist once his teeth come through and tell the dentist that your baby has a soy formula. There is concern that soy-based formula could affect reproductive health because soy contains phytoestrogens, substances found naturally in some plants, which may mimic or block the action of the hormone estrogen. The US has yet to issue a conclusive recommendation on this and since this is a sensitive time in a baby's development, it is not clear whether soy-based formula could affect reproductive development.

Q: How should I hold my baby when I'm giving him a bottle?
A: Bottle-feeding can be a wonderful time for bonding with your baby by holding him close. Find a position that both you and your baby like—think about whether you are right- or left-handed and the age and size of your baby. You can cradle your baby, or simply sit your baby on your lap. You will help reduce gas by giving your baby his bottle in as upright a position as possible. Also take care to tilt the bottle so that the nipple and neck are always filled with formula and never leave your baby to feed unattended by propping the bottle up. Ask your pediatrician for further advice.
Q: How long do you need to sterilize bottles for?
A: The recommendation is that you sterilize bottles and nipples for at least the first year of your baby's life. It is during this time that they are most vulnerable to germs and viruses, which if contracted could cause illness and possibly dehydration. Boiling bottles in water for 15 minutes will sterilize bottles after purchase. Thereafter, a dishwasher, set to 165° F (74° C) will sterilize bottles and accessories.
Q: Can I make up feedings in advance?
A: Ideally, you should make up each feeding as you need it. The risks associated with using powdered infant formula are reduced if each feeding is made up fresh, since the longer the formula is stored, the greater the risk of bacterial growth. However there are times when this is not practical, for example if you are going to leave the house for an extended period, or if you are leaving a baby at a day-care center. In this case, you should prepare the feedings in separate bottles as instructed and store them in the fridge (see Pre-made feeds). Throw away formula left out of refrigeration for over two hours and throw away the formula left in a bottle after a feeding.
Q: How long can pre-made feeds stay in the fridge?
A: Although it is not recommended that you make up bottles of infant formula in advance to store in the fridge because of the risk of bacteria developing, if you need to do this, store them in the back of the fridge, not the door, to ensure they are below 41° F (5° C) and never store feedings for longer than 48 hours. Formula is not suitable for freezing.
Q: Is it safe to warm a bottle and take it out to use later on?
A: Carrying warm formula in an insulated carrier is not safe, since warm milk is a good breeding ground for bacteria. The safer option is to make a bottle up fresh for your baby just before it is required. If you are out, you can carry boiled water in an insulated container ready to mix with formula powder when you need it. Ready prepared formula that comes in little cartons is a more expensive option, but handy for instantly decanting into a sterilized feeding bottle. If your baby is reluctant to take milk at room temperature, you could use a travel bottle-warmer, which can also be used to heat up containers and jars of baby food.
Q: What precautions should I take making feedings with bottled water when I'm traveling?
A: When using bottled water to make up a feeding, make sure the seal is still intact. Unless labeled as “sterile,” bottled water should be considered “clean” only. This means that for an infant less than 3 months of age, the water should be boiled for at least one minute before using it to prepare formula, after opening. For convenience, you may prefer to use smaller bottles of mineral water if you are traveling from place to place. For extra convenience, ready-to-feed formulas are available in cartons so you do not have to carry bulky cans of powdered milk with you. Although more expensive, these cut down on the amount of work you have to do while traveling and they give you the peace of mind that you can be sure of good hygiene for your baby in the absence of adequate facilities.
Q: I've heard that bottle-fed babies have smellier poop—is this true?
A: This does seem to be the case. Bottle-fed babies may have one bowel movement a day or only have a bowel movement once every three or four days. Both are normal. A bottle-fed baby's stools are pale brown, smelly, and more formed than those of a breast-fed baby. Some baby formulas give a greenish tinge to the stool. It is thought that unabsorbed fat causes the unpleasant-smelling stools in formula-fed babies. Breast milk is better absorbed, which means the stools usually have less odor.
Q: Will my baby get more gas if he is bottle-fed?
A: Gas refers to the air in your baby's tummy. It is swallowed along with milk during your baby's feedings, but also when he cries. It will fill his tummy before he has had enough milk and be uncomfortable. Also, the faster flow of milk from a bottle can make babies take in more gulps of air. Some babies suffer with gas and need burping after every feeding. Breast-fed babies tend to have fewer problems with gas than bottle-fed ones because they control the flow of milk at the breast and so suck at a slower pace, thereby swallowing less air with the milk. Breast-fed babies also have smaller and more frequent feedings than bottle-fed babies and they may be fed in an upright position, both of which can reduce gas.

Some babies have trouble bringing up gas and their discomfort is quite obvious. You can reduce gas by feeding your baby in an upright position and tilting your baby's bottle so that the nipple is full of milk—and not air. If your baby doesn't burp after a couple of minutes, he probably doesn't need to. You can burp your baby by gently rubbing his back or placing him over your shoulder. Some babies only seem to be able to get rid of gas through hiccuping. If the gas is severe, see your pediatrician who may suggest medication that will provide your baby relief.

Q: Is it OK to give my baby water as well as milk?
A: Formula, in general, does tend to be less thirst-quenching than breast milk because the strength of formula doesn't vary, whereas breast milk varies in consistency. For example, the beginning of a feeding with breast milk tends to be more watery than the end of a feeding of breast milk. If your bottle-fed baby still seems hungry after a feeding, it could therefore be that he is just thirsty and some cooled boiled water may be the answer in helping to placate him. In hotter weather he may need regular extra doses of cooled boiled water to quench his thirst.
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