Breastfeeding & Bottle Feeding | Bottle Feeding | Bottles
| Formula Transition
All Formula or Supplement
Once you decide you are bottle feeding you then need to decide whether you are feeding solely with breast milk, only with formula, or as a supplement to breast milk. If you decide to feed with formula then you need to decide which formula to use. I hadn’t given the type of formula to use any thought before I delivered my baby. I didn’t realize there was that much of a difference in the types of formula.
Remember that according to the U.S. Surgeon General’s public health report, “health professional organizations… officially recommend that most infants breastfeed for at least 12 months. These organizations also recommend that for the first six months infants be exclusively breastfed, meaning that they not be given foods or liquids other than breast milk” (356).
With my first baby, I combined formula feeding along with breastfeeding. When traveling, it was easy to store the powdered formula in a container and simply have water in the bottles and when it was time to feed my baby I just had to mix the two. I didn’t have to worry about keeping the bottles refrigerated. With my first baby I never felt comfortable breastfeeding in public so I generally fed my baby a bottle in public places. With my second baby, I used the MOMMBY Peek-a-Bye-Baby™ cover and felt comfortable nursing anywhere.
You may need to give your baby formula even if you don't plan on it. With my first baby it was easy to transition him to formula when I had an eye infection because he was already use to it. Giving my son a minimal amount of formula allowed his body to adjust to it so when I had to give him more formula it was not as if I was introducing him to formula 100% for the first time. When introducing things, whether formula, different types of formula, or transitioning to whole milk (after one year of age) I like to follow a gradual plan, as discussed below. For my daughter since she was exclusively breastfed, I ensured I always had sufficient supplies of breast milk on hand and I never had to transition her to formula.
It is your personal preference whether you decide to breastfeed, bottle feed, or both. It is also a personal preference whether you bottle feed with breast milk, formula, or both. With my son, since we allowed the hospital to give my baby formula his first week of life (they recommended it since he didn’t seem to be eating successfully enough from me) we then continued to give my baby formula when we got home from the hospital. Initially it was probably an 80% breast milk/ 20% formula mix. With my daughter, I decided to exclusively breastfeed I continued to breastfeed her until she was two years old. My daughter would occasionally take a bottle of breast milk but nursed most of the time. I bought a container of Earth's Best Formula when she was around 9 months old but never needed to use it.
Type of Formula
As you will soon learn, there are many different types of formula; milk-based (generally includes lactose) or non-milk based (corn syrup solids may be main ingredient) such as soy based or a hypoallergenic. You can choose from a formula with 100% whey, formula with 60/40 or 48/52 whey to casein ratio. You can choose to buy an organic formula and/or one with probiotics. You may want to confirm the formula contains DHA & ARA support. I think most of the formulas now contain DHA and ARA support which is found to improve brain and vision development (Greene). You can decide to continue offering formula designed for the older baby even after the child turns one and is able to drink whole milk.
The companies which manufacture the formulas are constantly changing, updating (and hopefully improving) the formulas so you will want to refer to the companies web site for most up-to-date information. Please refer below for some formula brands:
- Earth’s Best – organic formula, may be mostly whey? This is what I bought for my daughter but ended up not using since she continued to breastfeed exclusively - http://www.earthsbest.com.
- Similac, 48/52 whey-to-casein ratio (Sears, “Standard”) has an organic version of its baby formula. Refer to its web site, http://similac.com.
- Ultra Bright Beginnings (www.brightbeginnings.com) which on its web site states it has more of the “easily-digested whey protein” and has an organic version.
How to Prepare – Distilled Water
You can decide to use the ready-made formula which is already mixed; you don’t need to add anything simply pour into the bottle and serve. We used the powder type and mixed it with tap water for the first six months. The type of water to use to mix in with the formula is something I didn’t consider until we switched to the Gerber Good Start formula. I was reading the can and it said to mix with distilled water. I asked my doctor and she said she debated the same issue as to whether she should use distilled water or regular water.
I started to get concerned with using 100% tap water with all the reports about the concentration of medications found in the drinking water. When using tap water, we did use our Brita to filter it and the Brita filter is suppose to remove chemicals such as lead, copper, mercury, cadmium, and benzene.
There is also the issue of too much fluoride in tap water. In some places, the water may have too little fluoride. At the time when I was giving my son primarily distilled water, rather than tap water, my dentist asked what water we used to make his bottles and I mentioned distilled water. He said that was a good idea as he felt his children were suffering from too much fluoride in the water, and this was a dentist’s children! My doctor said that if the baby has eight ounces of water from the tap each day that should provide him enough fluoride. Thus, I would make approximately one or two bottles using tap water (filtered with our Brita) and the rest of the bottles with distilled water. You should find out how much fluoride is in your water and check with your doctor.
Too much fluoride in water brings up the issue of using the special water you can buy at places like Babies R Us that says with added fluoride. I would be concerned that if you solely use fluoride enriched water that it may provide too much fluoride? Although, you would hope that it would not be marketed special for children if that is the case?
For more information on bottles vs. tap water, please refer to this link at the Ask.Dr.Sears Site.
When we were in the hospital they gave my son the Enfamil bottles (ready-to-use) and he seemed to like it and do well with that so we continued to use Enfamil when we got home. We did transition to the powdered formula rather than ready-to-use primarily due to cost. Please refer to http://www.enfamil.com for more information. Later when my son started having constipation and undiagnosed reflux issues, we tried various other formulas to see if any helped.
Nutramigen (Hypoallergenic Formula)
We continued using the standard powder Enfamil until around 4 months. Around that age my son started to have issues drinking his bottle mostly due to acid reflux (which wasn’t diagnosed until after 6 months) and also seemed to have worse constipation. At that time we tried other formulas such as the Nutramigen, a hypoallergenic Enfamil formula brand which is suppose to manage colic within 48 hours. This formula is suppose to be easier to digest and would help especially if the infant has a cow’s milk protein allergy or other protein allergies.
I don’t remember the price exactly but it was significantly more expensive than the standard brand. We didn’t notice a difference using this formula so we went back to the standard brand. When introducing the Nutramigen we mixed it with the standard brand as it tasted significantly different. At first, I didn’t understand why my son made such a funny face when we gave him the Nutramigen until I tasted it!
I’m not sure if we needed to use Nutramigen longer but I would think that we would have noticed some difference after using the entire container especially since in the promotional material states you should notice a difference within 48 hours. Since the hypoallergenic formula didn’t seem to be improving any of my son’s symptoms I preferred to go back to a milk-based formula since most of the non-milk based formulas have corn syrup solids as the main ingredient. To find out more about corn syrup solids please refer to the next section.
In addition, recently I read on the Dr. Sears web site that the hypoallergenic formulas may have additional salt. In general, like most things, if you strip out the main ingredient (in this case lactose) generally other ingredients are added to compensate. According to AskDrSears web site, “[h]ypoallergenic formulas should not be used without a doctor’s recommendation, and then only if there is a definite medical reason. Don’t switch to one of these formulas just because baby is “fussy” without trying different standard formulas first” (“Hypoallergenic”).
Non Milk-Based Contain Corn Syrup Solids
I noticed with the nonstandard formulas the first ingredient generally listed was corn syrup solids. I felt corn syrup solids seemed like a strange main ingredient but when I discussed it with our son’s doctor he said that was fine. Doing my own research, I found the following information:
“Lactose is the main carbohydrate source in breast milk, and it is also the primary carbohydrate source in cow’s-milk-based formulas.... Lactose-free, soy, and special formulas contain one or more of the following carbohydrates: sucrose, corn maltodextrin, modified cornstarch, or corn syrup solids” (BabyCenter).
Even though most of the non-standard formulas contained corn syrup solids if my son wasn’t actually allergic to the milk based formulas I preferred to use milk based. Recently, many months after my decision, I found information on the Dr. Sears’ web site seems to agree and states “substituting other sugars for lactose may not be a good idea” (Sears, “Hypoallergenic”).
During our formula trial period we also tried a soy based formula. My son seemed to be fussier during the transition to soy formula. This may have been since we didn’t do a slow transition like we usually do when introducing new things to our baby. (Refer to the section below, “Slow Transition with New Formula” for more information about a gradual transition when trying new things.)
Not sure if a slow transition would have helped but we also abandoned the soy based formula; my mommy instinct just told me that if we could get a milk-based formula to work, I’d prefer that. (A lot of parenting for me has had to come from my mommy instinct, since there is so much information and conflicting information at times ultimately I have to go with my mommy instinct as to what I feel is best for my son.)
Recently, many months after this decision I was reading the Dr. Sears web site, and they do not promote the use of soy based formula and instead “recommend that parents being their baby on a standard cow’s milk-based formula unless advised otherwise by their doctor” (“Soy”).
In the Dr. Spock’s Baby and Child Care book, he states
soy milk formulas offer some health advantages over those made from cow’s milk. Some infants develop allergies to proteins in cow’s milk formula, and such formula may be a cause of excessive crying….Soy formulas don’t have these problematic proteins, and they are also free of lactose, which some infants find hard to digest…(286).
Dr. Spock goes on to state that there may be “health risks to soy formulas, too. They tend to have much higher concentrations of aluminum. It’s clear that aluminum does no good in the body, and in preterm infants (at least) it can cause serious harm….Still, ingested aluminum has been linked to the development of Alzheimer’s disease in older people…” (286 and 287).
My friend’s baby did really well on soy formula over milk-based formula so once again you have to find what works best for your baby and continue to consult with your medical professional.
My Favorite: Gerber Good Start Whey Based
Around 6 months our new doctor recommended trying Gerber (Nestle) Good Start since it is 100% whey based. Breast milk contains a whey/casein ratio, “a 70/30 whey/casein ratio is more typical of human milk, and the whey content of some human milk can be as high as 80 percent” (Sears, “Standard”). I had previously read that some babies and children don’t tolerate casein well and thus I thought it was worth trying to switch. Before our doctor had recommended switching to a non-casein formula, I actually tried to find formulas that did not have casein but I was unsuccessful as I didn’t realize Gerber Goods Start was 100% whey. “Enfamil promotes 60/40 whey-to-casein ratio… Similac …[has} 48 percent whey and 52 percent casein” (Sears, “Standard”).
Our doctor said the whey tends to be easier to digest and may help with acid reflux and constipation. We did feel after starting the Gerber Good Start formula we noticed some improvement with both acid reflux and constipation.
Gerber Good Start Protect Plus with Probiotics
After starting my son on the standard Gerber Good Start formula, I noticed the Gerber Good Start Formula which stated it provided immune support. I checked with my doctor to see if I should switch to that one and she said it probably wasn’t necessary since my son seemed to be a healthy baby. Based on her response it didn’t sound like she knew what additional ingredients were included in the formula to make it have immune support.
When I looked into it more the immune support was due to probiotic cultures added to the formula. Probiotics are “…healthful bacteria [which] live in our intestines. They play a critical role in regulating both our intestinal immune system and our internal immune system” (Sears, The Vaccine Book 189).
I felt especially due to the fact that my son had constipation that it wouldn’t hurt to use the formula that contained probiotics. I had previously already bought a lot of the standard non-probiotic formula so I ended up mixing every bottle with half standard and half probiotic after doing a slow transition of introducing the probiotic formula. I think most of the other formula brands now also have a version of this probiotic immune support formula.
I didn’t think about getting an organic formula until I really started to turn my household green when my son was around 15 months and thus he was basically finished with baby formula by this time. In addition, I didn’t think I thought about it as much when I was buying my son’s formula since there didn’t seem to be a lot of organic versions where I was shopping at the time. Now 99.9% of everything in my house is organic or natural so with my second baby I bought Earth's Best organic formula but she never drank it since she was almost exclusively breastfed. Please refer below for some organic brands.
- Earth’s Best – the first ingredient is organic reduced minerals whey. I didn’t see casein listed so this may be a 100% whey formula? At this time Earth’s Best didn’t appear to have a probiotic version. Refer to this link to get to Earth’s Best web site: http://www.earthsbest.com.
- Similac, a major formula brand, also has an organic version of its baby formula. Refer to its web site, http://similac.com.
- Ultra Bright Beginnings (www.brightbeginnings.com) which on its web site states it has more of the “easily-digested whey protein.”
You may also want to refer to the https://babyorganic.com web site for more information on organic baby formulas to purchase. I won’t be surprised if by the time I have another baby all of the main brands of formula carry an organic version that also includes probiotics and possibly a greater whey/ casein ratio.
Gerber Good Start 2 (9 – 24 months)
I knew that I would need to use part formula for some time after my son turned one so I started introducing the Gerber Good Start 2 for 9 – 24 months when my son was around 11 months old. I had previously asked at his 9 month visit if it was a good idea to use formulas like this for 9 – 24 months once the baby is over one and the doctor said whole milk would be sufficient and a formula is not needed.
Although, knowing my son’s past history with changes in formula and still some issues surrounding drinking his bottle I didn’t expect to transition him immediately to drinking whole milk the day he turned one. I also didn’t think it could hurt to continue to use some formula that provided vitamins, minerals, and some additional immune support.
The Gerber Good Start 2 for 9 – 24 months formula cost less than the 0 – 12 months formula; probably because this formula is competing against the cost of whole milk which is significantly cheaper than the infant formula. I was happy to read on the Gerber Good Start web site, that the Protect Plus and the Gentle Plus 2 formulas also contain the “easy-to-digest 100% whey COMFORT PROTEINS.”
As of July 2009, refer below for a comparison of formula for 0 – 12 months compared with 9 -24 months per 100 calories (5 fl ox, prepared as directed):
||Gerber Good Start
0 - 12 Months
|Gerber Good Start
9 - 24 Months
I gave my son formula for a 9 – 24 month old (mixed with whole milk once he was 12 months) until he was almost 17 months old. Refer to this link for more information on our transition to whole milk.
Slow Transition to New Formula
If you transition from breast milk to formula or from one type of formula to another type of formula it is best to do the transition gradually. Once it is time to transition to whole milk (baby is 12 months) then you may also want to do that transition slowly. At the Gerber web site there is a sample schedule which describes the transition from breast milk which I’ve used to help when transitioning to other types of formula. Refer to this link. The schedule states to try the following assuming eight feedings a day.
- Day 1, 2, 3 switch out one feeding with formula.
- Day 4 and 5 switch out two feedings with formula.
- Day 6 and 7 switch out three feedings.
- Day 8 and 9 switch out four feedings.
- Day 10 and 11 switch out five feedings.
- Day 12 switch out six feedings.
- Day 13 switch out seven feedings.
- Day 14 switch out all feedings.
When I switched formulas, I actually would mix the new formula with the old formula rather than giving one bottle all new and one bottle all old. This worked better for me as the different formulas had distinctively different tastes and if I gave my son the new one he generally wouldn’t drink it. It also helped to mix since at the stage when we were trying new formulas my son never finished a bottle so by mixing he could have a little bit of the different types at each feeding.
I generally didn’t mix the formula with breast milk as since he didn’t finish the bottles I didn’t want to waste the precious breast milk if it was mixed with something else. But if you are trying to transition to formula it may help to mix the formula with breast milk. My son didn’t seem to mind switching between breast milk and formula.
If after reading this article you decide to choose a specific formula for your baby, it may be wise to take that formula to the hospital rather than starting the baby on one formula provided by the hospital and then switching to another one. You may want to take the ready-made liquid version to the hospital as it is probably easier to use. You would also want to take some bottles or nipples to use as well. It’s probably best to discuss these options with the hospital before your arrival. Please refer to “Storing Breast Milk and Formula,” “Bottles,” and “Nipples" for more information on bottle feeding. You may want to read “How Much Should Baby Drink” or “Feeding Tricks” as well. Or please refer to the “Breastfeeding” section for more information on breastfeeding.
Don’t Give Up
Please remember that the Gerber Good Start formula worked well for me and my first baby but you need to determine what works best for you and your baby. It is important to find the right formula type since if you are formula feeding, then formula provides the baby’s nutritional needs for the first year of life.
Be patient…and good luck.
BabyCenter. “Choosing Formula: A Primer.” BabyCenter. 8 Nov. 2009
Galson, Steven K. “Surgeon General’s Perspectives: The Status of Breastfeeding Today.”Public
Health Reports 124 (May-June 2009). 8 Nov. 2009
Greene, Alan M.D., and Cheryl Greene. “Exciting Breakthrough in Infant Formula.” drgreene.com. 8 Nov. 2009. < http://www.drgreene.com/21_797.html>.
“Gerber Good Start Formulas.” 8 Nov. 2009 <http://www.gerber.com/Products>.
Sears, Robert W. M.D., F.A.A.P. The Vaccine Book: Making the Right Decision for Your Child. New York: Little, 2007.
Sears, William M.D.,Martha Sears, R.N., James Sears, M.D., and Robert Sears, M.D.” Bottlefeeding: Hypoallergenic Formulas.” AskDrSears.com. 8 Nov. 2009.
---. “Bottlefeeding: Soy Formulas.” AskDrSears.com. 8 Nov. 2009.
---. “Bottlefeeding: Standard Formulas.” AskDrSears.com. 8 Nov. 2009.
Spock, Benjamin M.D. and Robert Needleman, M.D. Dr. Spock’s Baby and Child Care. New York:
“Transitioning from Breast Milk to Formula.” 8 Nov. 2009
Last Updated: November 2011; November 2009