Bottle Feeding: Whether It's Formula Or Breastmilk, How To Prepare For The Bottle

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6.96 MB 17:21 Min


Our Experts In This Episode 

Dr. Bryan Vartabedian is an Assistant Professor of Pediatrics at Baylor College of Medicine and serves as an attending physician at Texas Children’s Hospital, America’s largest children’s hospital.  He is also the author of Colic Solved: The Essential Guide to Infant Reflux, and the Care of Your Crying, Difficult to Soothe Baby.  Learn more at Dr. Vartabedian's website,


Katy Lebbing is the manager of the Center for Breastfeeding Information at La Leche League International, the world's largest breastfeeding support group.  Lebbing is also a La Leche League leader and an international board-certified lactation consultant. 




Welcome to your Pea in the Podcast, I'm Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy.


This week, we'll talk about feeding your baby with a bottle. Whether you think you might pump and feed your baby mother's milk or combination feed with formula, or if you think you might want to exclusively formula feed…


"My husband wasn't as on board with that, and I’m like, 'the day you can breastfeed is the day that we'll breastfeed.  How does that sound?' "


We'll you get started. We'll help you pick bottles and nipples and formula, which can involve some trial and error.


"We're just going back to the Enfamil because obviously the Similac doesn't work as well for her."


And we'll prepare you for the challenges a formula-fed baby might face…


"Profound irritability, diarrhea, mucus in the stool, even vomiting and reflux-like symptoms."


A pediatrician who is also the author of the book Colic Solved, and a bottle-feeding mama help you to decide if bottles are right for you in this Pea in the Podcast.


We hear it all the time - breast is best.  So why would a new mommy consider formula feeding? Dr. Bryan Vartabedian is a pediatrician at Baylor College of Medicine and the author of Colic Solved: The Essential Guide To Infant Reflux and the Care of Your Crying, Difficult to Soothe Baby. He says for some moms it seems like it might be easier.


"Mothers don't have to go through the period of adjusting to breastfeeding during the first couple of weeks, which can be very difficult, and it's a good option for moms who can't breastfeed."


Some moms struggle with milk supply issues and find they do have to feed their baby some formula. But other moms decide they will bottle-feed full-time, like Lynn…


"My husband wasn't as on board with that, he kind of wanted the whole breastfeeding thing, and I’m like, 'the day you can breastfeed is the day that we'll breastfeed.  How does that sound?' He's like, 'okay, I guess you win this one.' "


Lynn knew throughout her pregnancy that that was the way she was going to go. And Pediatrician Bryan Vartabedian says formula is fine.


"Formula is nutritionally complete. There are some differences in infectious outcomes that we've seen breastfed versus bottle-fed babies, but for those parents who can't breastfeed, they can feel reassured that the formulas that are available on the market today are actually quite complete."


So if formula feeding is for you, where do you begin?


"Bottles, lots of bottles. I actually bought 3 different kinds of bottles to start with because I had no idea what I was doing. I didn't know anything about bottles and so I bought Dr. Brown's, I had one free Advent bottle, I had some VentAires and then because I’m like ‘these are drop-in liners, that looks like the easy, lazy mom way to go’, I bought some of those. And when we brought her home from the hospital, we could actually use the bottles they had provided in the hospital, but they only held an ounce, and so by the time she was past needing an ounce, we had to use something we had at home. And we actually went through all of the bottles and ended up using the ones with the drop-ins, just because they worked the best for her. I’m like ‘oh, good deal -- lazy mom and the drop-ins and they work!’"


As you consider which baby bottle to buy, you might want to keep in mind the growing concern over Bisphenol A.  That's a chemical used to make hard, clear, polycarbonate plastics found in many baby bottles. BPA-containing products have been banned in Canada after some researchers linked BPAs to testicular and breast cancers, early puberty, hyperactivity, and autism. As many states and other countries wrangle with BPA bans, more American companies are coming up with BPA-free alternatives. Of course, good old-fashioned tempered glass bottles will always be BPA-free; opaque or cloudy plastic bottles will also be free of the chemical.


Your formula container may also be lined with a resin containing BPAs. Keep your eye out; some major baby retailers are now taking back BPA-containing products in exchange for BPA-free products.


For more information on Bisphenol-A, The Green Mommy has a primer here. The Environmental Working Group is a great resource for health related information on not just Bisphenol-A, but many other potential environmental issues that could impact you and your family.


And visit the ITAP Health Observatory for a Smart Guide to Plastics, and info on how to choose the safest plastics available.


Some moms find they have more trouble finding the right nipple.  They come in all shapes and flow rates. Slow flow for the new baby who is still learning to suck and develop their muscles, medium flow for the older infant and fast flow for a baby who is ready to have a bottle quickly and go. So you, like Lynn, may find the recommended flow rate doesn't work for you.


"The nipples they gave us in the hospital with the bottles seemed to be very fast-flowing compared to the slow flow nipples that all of the boxes and everybody recommends for a newborn, and she would get so frustrated that she would fall asleep in the middle of the bottle, wake up 30 minutes later still hungry because she hadn't finished the original bottle and so I went back to the store, I tried out all of these different nipples and eventually went to fast flow nipples, which aren't recommended until they are 6 or 8 months old and I went to them when she was 4 weeks old and there was some dribbles, but at least she was eating enough that she wasn't waking up 20 minutes later starving because she had fallen asleep because she was working so hard to get anything out. So that was our biggest struggle, the nipples and the flow."


Like with so many mommy issues, it’s all trial and error. This is certainly true when you're trying to pick a formula. There are so many out there, it can be overwhelming.


"The hospital had given us some Enfamil, and not really knowing which formula we wanted, didn't want, I of course had gone out and signed up on all of the formula websites to get free samples and stuff, so we had some stuff at home, but when they sent us home from the hospital they gave us whatever was in her cart to take home and so we fed that until it was gone. Then we had another can of Enfamil at home; we just used that. And then all we had left was the Similac so we tried that and, of course, being paranoid, she didn't poop for like 36 hours after I started that and I'm like, ‘okay we're just going back to the Enfamil because obviously the Similac doesn't work as well for her.’ So we went out to the store, bought the Enfamil, within 12 hours she was pooping normally again and I was like, ‘oh, okay, we're just going to stick with this.’ Maybe a couple of weeks later, I’m like, ‘you know, it's so expensive, let's go to a cheaper off-brand like the Wal-Mart brand or whatever’, tried it, again 36 hours later she still hadn't pooped and I’m like, ‘okay this is a sign, we're just going to stick with the Enfamil.’ "


With formula feeding -- like with breastfeeding -- there are challenges, and one of the big ones is that a lot of babies are sensitive to cow's milk protein. Of course, formula is made of cow's milk, not human milk. You can't predict who will have trouble and who won't, but if you have a cow's milk protein sensitive baby -- and I did -- after a couple of weeks you will definitely know it. Dr. Vartabedian says there are an array of symptoms.


"Profound irritability, diarrhea, mucus in the stool, even vomiting and reflux-like symptoms. Often times you'll see blood in the stool. Those are some of the big issues that we'll see with babies who are bottle-fed."


He mentioned profound irritability, otherwise known as colic.  My baby had it bad. Sometimes the only symptom of cow's milk protein intolerance will be reflux, or another baby might have just constipation and a third baby might just have eczema, or another baby might have all of the symptoms that Dr. Vartabedian mentioned together. Cow's milk protein intolerance is sometimes called an allergy, but it's not a true allergy, and the doctor says in infants, you can't test for it.


"The allergic reactivity we see during infancy is different than a lot of the other types of food allergies that we see in an 8-year-old and a 10-year-old. The allergic inflammation in many babies tends to be limited to the lining of the intestines, so all we'll see in a baby may be loose stools, mucus, irritability, colicky behavior, sometimes vomiting. Rash can sometimes be seen, but it is seen in a minority of babies."


So if you're formula feeding and your baby starts showing signs of cow's milk protein intolerance, what do you do? Well, if you're combo feeding, you can try to move to exclusive breastfeeding. If you are exclusively formula feeding, you can try to re-lactate, that is get your milk supply back so that you can try breastfeeding again. There is a lot of great advice about that at a wonderful breastfeeding support website called Re-lactating can be difficult, but it can be done.


If you're just going to stick with formula, you can try one of the partially hydrolyzed formulas. In them, the cow's milk protein is partially broken down.  That is what partially hydrolyzed means. Since the cow's milk proteins are partially broken down, it may be easier for your baby to digest and they’ll have fewer allergic symptoms.  There are a couple of brands on the market, and one of them has now added probiotics, you know the good stuff that is in yogurt?


"Nestle Good Start is the first FDA-approved formula available in the US market supplemented with a particular probiotic, and this probiotic is helping bottle-fed babies develop colonic flora.  Those are the good bacteria in the colon that match that of breastfed babies, and it is felt that that bacterial colonization in the breastfed babies is one of the things that leads to their improved health."


If your baby still seems to be struggling with symptoms of cow's milk protein intolerance after moving to a partially hydrolyzed formula, you can try a fully hydrolyzed formula. In those, the cow's milk protein is completely broken down. My combination-fed daughter needed this type of formula. The only problem is, it is expensive.


"No kidding. For Nutramigen, which is the Mead Johnson product, for a 3-4 month old baby will run you about $600 per month, which is pretty costly, so you really want to make sure that you have a good case for protein allergy. You want to talk to your doctor, see to it that they are checking the poop for microscopic blood; that is a helpful clue.  Or if you are seeing lots of mucus in the stool and colicky behavior, that is often times a strong clue."


Some health insurance companies will help you pay for this formula if your doctor says your baby needs it. WIC will cover it, too. Here is a sample of the document from the Pennsylvania WIC program asking for a Doctors prescription for formula, and you'll notice hydrolyzed protein formulas are on the list.  However, every state's WIC program runs a little differently, so the process may be different for you.


Some people will suggest you get lactose-free formula for a cow's milk intolerant baby. Dr. Vartabedian says that won't help.


"There's a lot of confusion about milk protein allergy and lactose intolerance. They’re two entirely different things. With milk protein allergy, a baby is actually having an allergic reaction to the protein found in that milk. Lactose intolerance is an entirely different thing. Lactose intolerance occurs when we take the milk sugar, lactose – again, not the protein – the milk sugar, lactose, and it doesn't get absorbed up high in the intestines. It gets dumped down into the lower intestines and gets fermented and makes gas and diarrhea. Lactose intolerance is actually quite rare in babies. We can see it after viral infections, and we can see it come on in older children, but it is quite unusual in babies."


Some will suggest a cow's milk protein intolerant baby should try soy formula; very often those babies will have a bad reaction to the protein soy formula as well. We skipped soy formula and just went to the partially and then fully hydrolyzed formulas, that was just us.


And a final note about cow's milk protein intolerance, breastfed babies aren't immune to it, although it is more rare.


"It's important for breastfeeding moms to understand that the protein that they take in in their diet will be expressed in small pieces in your breast milk, but I do always make the point with breastfeeding moms that a baby is reacting to the protein in your milk, not necessarily to your milk, because parents, mothers feel very, very bad if they think their baby is reacting to them."


If your breastfed baby is cow's milk protein intolerant, they will do better if you temporarily eliminate the dairy from your diet. By the way, at least one study has shown that cow's milk protein intolerance is more common in babies born by c-section (like mine).


After all that talk about cow's milk protein intolerance, it is important to note that many babies have no problem tolerating formula. Lynn's daughter did pretty well on it. She had a few minor problems.


"She had a little bit of silent reflux right from the start where she was not a terrible spitter, but she would spit up a little bit after every feeding.  We kind of took care of that with using the drop-in liners and pressing all of the air out of the bottles before we fed her, so we didn't have to switch formulas or anything like that."


Lynn says keeping bottles clean and ready wasn't too big a problem for her.


"The bottles that we used were not.  The Dr. Brown's bottles have a lot of parts to them, so, yeah, they’re kind of a pain, but ours were really easy because we used drop-in liners and we basically just threw the nipples -- we bought a little basket for the dishwasher -- we’d throw the nipples in there and everything, and just washed the bottles in the dishwasher and be done with it."


She found a way to make travel easy, too.


"I would fill a bottle with tap water before we would leave home and just keep it in the diaper bag, and when it was time for her to eat, I'd put the formula in, shake it up, press the air out and feed it to her, and she was happy with that."


Another thing, a lot of people will tell you you need to warm up formula bottles. You really don't.


"We did at first because we thought that was the thing to do, but she had most of her bottles made with room temperature, or I mean, tap water room temperature water. We didn't really heat them up or anything like that. Unless I made a batch and put in the fridge, then I would put it in a cup of hot tap water for a couple minutes and just take the edge off. She always took her bottles pretty much room temperature or even a little cooler than that and so we never microwaved them. We had a bottle warmer, I actually gave it to the neighbor when she had a baby because she was going to breastfeed and she was like ‘I need a bottle warmer,’ I was like ‘you can have ours we never use it.’ I didn't really use that."


So what advice does Lynn have for you if you are preparing to bottle-feed?


"I would say, have a couple of different bottles on hand, maybe a couple different kind of formulas and start with that.  You can always go out to the store, or send your husband out if you need something different, but it is easy to do and it works. I think it was the right decision for us as a family and it worked out well for us."


Dr. Vartabedian says you can always reach out to your pediatrician.


"Your pediatrician is going to help guide these decisions. I would say, in general, if you can try breastfeeding first, that's going to be an easy first option. Look to your pediatrician for guidance, my book Colic Solved has a lot of great information about how to recognize feeding intolerance versus allergy and all of the problems that babies can run into with their formulas."


And Lactation Consultant Katy Lebbing says no matter whether you choose breastfeeding or formula feeding, those early weeks are going to be intense.


"No matter how you are feeding your baby, if you've never had a baby before, it is a giant learning curve. Babies need our help constantly, they want to be held constantly, no matter how they are fed and mothers don't often understand the intensity of the needs of a newborn. So that again is where it is so important to meet with other mothers and to observe how they handle their little ones."


Support is key, mommy. Start rounding up your friends and family now.


We hope you've enjoyed this Pea in the Podcast: Bottle Feeding. Please visit our website for more information about our experts, to find links and transcripts and to register to get tailored week-by-week shows for each week and stage of your pregnancy. It's everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I'm Bonnie Petrie, thanks for listening.


A Special Thanks To...


Lynn in Wisconsin for sharing with us her experiences with bottle feeding, and some wonderful advice, too, for this podcast.