Infant Bottle Feeding Support

When starting out bottle feeding with formula or breast milk, whether the breast milk is expressed from the mother or obtained from a breast milk donor, the general guidelines are to begin with small amounts the first day (15-30 ml per feed = 1/2 to 1 ounce) every 2-3 hours, then increase to larger amounts each day (30-60 ml = 1-2 ounces on day 2) to reach a target amount of 7 to 11 ml per pound per feed every 2-3 hours during the day and every 3-4 hours at night on average, by day 3 to 4.

For example, a baby weighing 8 pounds should get 56 to 88 ml (= 2 to 3 ounces approximately) per feed by the 3rd or 4th day of life every 2-3 hours during the day, and every 3-4 hours at night. As the infant rapidly gains weight, he/she will need more daily formula, so that this baby with a birth weight of 8 pounds will probably take 3-4 ounces per feed by the age of 3 to 4 weeks.

Also, babies who are bottle-fed tend to swallow more air during feedings, and so it is important to spend extra time holding the baby upright and burping him/her after each feeding, to get the air 'burped out" to prevent bloating and gas pains.

There has been discussion of opinions that formula feeding is associated with risks to the health of babies. However, it is clear that some mothers cannot breastfeed, such as in cases of adoption, legal custody issues, or for orphaned babies. Rest assured that there has never been any toxic agent found in any of the infant formula brands or types that pose a risk to the infant's health, according to the U.S. FDA.

Studies that are often quoted as arguments that term infants are more likely to get pneumonia, ear infections, SIDS, meningitis, hospitalization for respiratory disease, or cancer/leukemia if they are not exclusively breast-fed are virtually all retrospective data collections, and those that are prospective are not sufficiently scientifically controlled to be conclusive in any way, except to suggest that proper prospective studies on these topics should be done: In analyzing this data to find out how orphaned or adopted babies may be protected from the purported 'dangers of formula feeding', I reviewed the literature which included meta-analyses of over 9,000 research articles, and discovered that differences in health outcome of breast-fed versus formula-fed  babies are likely to be solely correctable by proper infant positioning of bottle-fed infants.

It is undeniable that breast-fed infants are being held, and are in physical contact with the mother, for several more hours during the day than bottle-fed infants. Simply by holding bottle-fed babies for more hours during the day, and not 'bottle-propping' during bottle feeds, for example, the health outcomes of formula-fed babies may be improved significantly. 

In fact, there are no prospective controlled studies in the literature comparing the health outcomes of groups of infants who were exclusively fed breast milk through a bottle compared to matched groups that were fed formula through a bottle. This type of study would need to be done to establish superiority or non-inferiority of breastmilk or formula, by removing the differences in positioning and other 'feeding mechanics' variables between breast feeding and bottle-feeding.

In fact, for proper scientific controls, other studies need to be done, where exclusively breast-fed infant health outcomes are compared to matched groups of babies that are 'sham' breast fed by keeping the babies held upright or in a breast feeding position for 30-40 minutes surrounding every bottle feed of formula. Studies like this have never been reported in the literature, either.

Clearly, these kinds of studies need to be done in the near future. Only in this way can we prove how best to feed orphaned or adopted babies to protect them from 'poor outcomes related to formula-feeding' that are discussed in the recent literature. In fact, we may see a "Hold your baby for health" movement in the future of formula-fed infants!

Written by Robert L. Bjork, Jr., MD