Holding & burping while bottle feeding

  • Hold baby cradled close to you in a more upright position
  • Gently touch your baby's lips with the bottle nipple. Wait for baby to open their mouth wide, then place the nipple in baby's mouth. Almost the entire nipple should be in the baby's mouth.
  • Hold the bottle steady. Avoid twisting or turning the bottle.
  • Bottles should not be propped. This can lead to several problems for your baby: ear infections, tooth decay or choking.
  • To remove air bubbles, position baby either on your lap or over your shoulder. Support the head and neck. Gently pat your baby on the back to help remove air bubbles.

  • Early on your baby should be burped after every ounce, and then after every one to two ounces or about halfway through the feeding as the baby grows.

  • After feeding, hold your baby in an upright position for about 15 minutes. Do this before putting them to bed or placing into a flat position on their back. This may help your baby to digest the feeding and prevent them from spitting up.
  • Spitting up small amounts of formula after burping may be normal, however spitting up large amounts of the feeding is something you will want to talk with the baby's health care provider about.
  • Bottle feedings should take between 15 and 30 minutes.

If you have questions or concerns about your baby's bottle feeding, please contact: your baby's health care provider, St. Luke's NICU Developmental Specialists (319) 369-8191 or St. Luke's Lactation Consultants (319) 369-8944.


Choosing Bottle Nipples for Newborns


  • Select a bottle nipple that is: slow flow (birth to 3-month stage), round shape and soft silicone.

  • Consistency is important.  Use the same type of slow flow bottle nipple at each feeding.  Using multiple types of bottle nipples is not recommended.

  • Using an orthodontic shaped (wide with a flat side) bottle nipple or pacifier may contribute to poor tongue movement and lead to speech concerns later on.  

  • As your baby grows, some may prefer a nipple with a faster flow rate and others may never need to change.

  • Tighten the ring on the bottle to be snug, but not tight.


If you have questions or concerns about your baby's bottle feeding, please contact:  your baby's care provider, St. Luke's NICU Developmental Specialists (319) 369-8191 or St. Luke's Lactation Consultants (319) 369-8944.


Philbin,M.K. & Ross, E.S.  (2011).  The SOFFI reference guide: text, algorithms and appendices: a manualized method for quality bottle feedings.  Journal of Perinatal & Neonatal Nursing.  25: 360-380.  

 

Signs of problems with feeding

  • Each bottle feeding should be a pleasurable and comfortable time for your baby.

  • Your baby should feed quietly. Quiet sucking, swallows and breaths.

  • Milk that flows too fast can be stressful and unsafe for your baby.

  • Signs your baby is feeding too fast from the bottle:

  1. Baby loses milk from sides of the mouth

  2. Baby is gulping

  3. Baby coughs, cries or pulls away from the bottle

  4. Baby raises eyebrows and looks worried or stressed

  5. Baby finishes the entire bottle feeding in 5 - 10 minutes

If you have questions or concerns about your baby's bottle feeding, please contact: your baby's health care provider, St. Luke's NICU Developmental Specialists (319) 369-8191 or St. Luke's Lactation Consultants (319) 369-8944.

Bottle feeding: How much and when to feed

The American Academy of Pediatrics suggests:

  • Watch and feed your baby when they show signs of feeding readiness. 

  • After the first few days, your baby will take from 2 to 3 ounces of bottled breast milk or formula every three to four hours, on average during the first few weeks.

  • During the first month if your baby sleeps longer than four to five hours and starts missing feedings, wake them up and offer a bottle.

  • By the end of the first month, your baby may take up to four ounces per feeding, and likely have a schedule of feeding about every four hours.

  • By six months your baby may take in six to eight ounces at each of the four or five feedings in 24 hours.

  • Your baby will most likely regulate the amount taken to meet their own specific needs. Let them tell you when they have had enough. You should not force your baby to finish a bottle with each feeding.

  • If your baby regularly seems to want more or less, keep a record of feedings and discuss this with your baby's health care provider.

  • Follow up with your health care provider as directed and discuss with them any questions you have.

American Academy of Pediatrics (2013). Retrieved July 7, 2014 from http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Amount-and-Schedule-of-Formula-Feedings.aspx.

 

Preparing and storing infant formula

  • Feed your newborn iron fortified formula feedings as directed by your health care provider. Follow manufacturer's label for mixing and storing any infant formula.

Preparing formula

  • Check expiration dates. Always throw away any expired formula.

  • Hands should be washed with hot soapy water and rinsed well before preparing bottles.

  • Bottles and nipples do not need to be sterilized but should be washed in hot, soapy water, or cleaned in the dishwasher.

Water for mixing powder or concentrated formula:

  • City tap water may be used for mixing infant formula. Cold water is recommended to reduce the amount of lead which could leak from the water pipes if hot water was used. Run cold water from the tap (15-30 seconds) before using.

  • Before baby is born, well water should be tested for bacteria and nitrates, before it is used for formula preparation. Contact your county public health department for a water testing kit.

  • If using bottled water it must say for drinking purposes.  Bottled water may have fewer impurities and contaminants, but could still have harmful bacteria.

Contact your health care provider and dentist with any questions or concerns.


How to safely prepare formula with water

  • Check expiration dates. Always throw away any expired formula.
  • Hands should be washed with hot soapy water and rinsed well before preparing bottles.
  • Bottles and nipples do  not need to be sterilized but should be washed in hot, soapy water, or cleaned in the dishwasher.
  • If using powder formula, mix well to make sure there are no clumps of undissolved powder in the bottle. Swirl instead of shaking to avoid making air bubbles.
  • Some babies prefer bottles at a cool temperature, others prefer bottles warmed. If your newborn prefers warm bottles: place bottle in a bowl of warm water or under running tap water to warm safely. Always check the temperature of the formula by shaking a few drops on your wrist before offering it to your newborn. It should be lukewarm, not hot. 
  • Do not warm formula or water in the microwave. This may overheat the liquid and can burn your baby's mouth.

Storing formula

  • If your newborn does not finish a bottle of formula within one hour, throw it away. Do not save it for later. During a feeding, your baby's saliva gets in the bottle and can cause bacteria to grow. Reheating or refrigerating will not kill the bacteria.
  • You can decide whether to mix it up as you go or prepare a full day's worth at a time and refrigerate it.
  1. Powder - prepared powder formula should be discarded after being in the refrigerator longer than 24 hours.
  2. Opened or prepared ready-to-feed or concentrate formula should be discarded after begin in the refrigerator longer than 48 hours. 

AWHONN.  (2006).  The Compendium of Postpartum Care, 2nd Edition. Philadelphia, PA:  Medical Broadcasting Company.

Jana, L., Shu, J. (2014). Retrieved June 11, 2014 from http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Formula-Form-and-Function-Powders-Concentrates-and-Ready-to-Feed.aspx

 American Academy of Pediatrics. (2014). Retrieved April 10, 2014 from http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/How-to-Safely-Prepare-Formula-with-Water.aspx

American Academy of Pediatrics. (2013). Retrieved June 11, 2014 from http://www.healthychildren.org/English/safety-prevention/all-around/Pages/Is-Your-Drinking-Water-Safe.aspx

Iowa Department of Public Health. (2014). Retrieved on June 25, 2014 from http://www.idph.state.ia.us/search/search.aspx?q=infants+0-12+core+nutrition+knowledge&x+25&y=12

Iowa State Hygienic Lab

Park, J., Thoyre, S., Knafl, G., & Nix, B.  (2012).  Bottle-feeding outcomes in very preterm infants: Preliminary effects of positioning.  Advances in Neonatal Care. 12: 242.  
 
Philbin,M.K. & Ross, E.S.  (2011).  The SOFFI reference guide: text, algorithms and appendices: a manualized method for quality bottle feedings.  Journal of Perinatal & Neonatal Nursing.  25: 360-380.  
 
Pridham, K., Steward, D., Thoyre, S. et al.  (2007). Feeding skill performance in premature infants during the first year.  Early Human Development.  83: 293-305.

Ross,E.S. & Philbin, K.  (2011).  Supporting oral feeding in fragile infants.  Journal of Perinatal & Neonatal Nursing.  25(4): 349-357.  

Thoyre,S.M. & Carlson, J.  (2003). Pre-term infants' behavioral indicators of oxygen decline during bottle-feeding.  Journal of Advanced Nursing.  43(6): 631-641.

Thoyre, S.M. & Brown, R. (2004).  Factors contributing to pre-term infant engagement during bottle-feeding.  Nursing Research, 53(5): 304-313.