Formula feeding education, or lack thereof

Reading through my Google alerts, I almost squealed with excitement when I saw a link entitled “Health Tip: Preparing Baby Formula” from none other than U.S. News and World Report. A major news outlet! Formula feeding education! Squee!

Well, turns out the article was less “squee” and more “eh”.

According to the esteemed publication, the formula-related health tip that was so vital that it necessitated being “called out” (publishing world lingo for highlighting a fact or quote) was the following:

Wash Your Hands.

The rest of the tips have to do with general hygiene- cleaning surfaces, sterilizing bottles, etc. I’m probably being unnecessarily snarky, because this is important information; it is important to keep things as clean and sterile as possible when making up an infant’s bottle. They also throw in one useful tip about keeping boiled water covered while cooling (great advice). But most of this is certainly not new information, and in many ways, I think it’s a waste of newsprint.

Why? First, I expect most parents know they are supposed to wash their hands and clean their bottles. What they may not know is why. There is no mention of the risk of bacterial infection here, so it just comes of sounding like vague, somewhat stodgy advice, like something your mother-in-law tells you in that tone. (You know the one.) The kind of advice that gets filed in the “I know I should do it, but come on, what’s the harm” portion of your conscience, alongside “floss twice a day” and “never jaywalk” (unless you are in Los Angeles. Then you probably take the jaywalking thing seriously, as the LAPD will ticket your ass for crossing where you shouldn’t). I think an acknowledgement that these precautions will help you avoid potentially deadly bacterial infections would make the advice seem a tad more topical.

But also, this is standard food prep protocol. There are other intricacies to formula feeding that may not be as intuitive- safety precautions like mixing the proper amounts of water to formula; not diluting the formula; using the right type of water; discarding formula after specific amounts of time; opting for ready-to-feed for newborns. Or what about other tips which might help avoid other formula-related health problems? Like a run down of the different types of formulas so that parents can choose the right type for their babies. Advice for understanding hunger cues. A bit of education on growth spurts; what’s normal when it comes to formula-fed babies and spit-up and elimination (both pee and poop); a quick description of how to feed a baby holding the bottle at a good angle?

I get that this was merely a half-column filler, not an 800-word feature. I understand that U.S. News & World Report isn’t in the business of imparting feeding advice to parents (and in fact, the article in question was syndicated, from Health Day) . And I seriously do appreciate the effort to give a bit of valuable info to formula feeding parents. Yet, I can’t help but wish that this half-column was put to better use. A short paragraph on when (and just as importantly, why) formula should be discarded would have been infinitely more interesting and useful.

There are a few reasons why formula feeding education is as hard to come by as a good house under half a million in the greater Los Angeles area (I’m bitter about real estate at the moment). Many people think it’s unnecessary; formula feeding is seen as the “easy way out”, and assumed to be as simple as scoop and shake. Some breastfeeding advocates believe that prenatal formula education/preparation is counterproductive to breastfeeding promotion – the theory being that if you discuss it, it will be taken as an endorsement, when formula should only be used in an all-else-has-failed scenario. (The World Health Organization’s “WHO Code” basically forbids health workers from even uttering the words “infant formula” until it becomes clear that there is no other option.)

What is puzzling to me about this situation is that breastfeeding, while definitely a lost art in our bottle-heavy society, does have an intuitive aspect to it. Or at least it is portrayed that way – something so natural, so instinctual, shouldn’t require training. Assistance, yes. Support, most definitely. Protection, you bet your bottom dollar. But instruction/education? That seems rather – well, quite literally, counterintuitive.

Formula feeding, on the other hand, is something which has always been a man-made, lab created, medically-approved (at least up until recent events) form of infant feeding. It does require instruction; you don’t see our primate cousins giving birth and popping open a can of Similac (although I am quite sure they could be trained to do so, considering how smart they are. I’ve seen Rise of the Planet of the Apes. Scared the bejesus out of me). Yet parents leave their prenatal classes and hospital stays with plenty of info on birthing and baby care and breastfeeding, but little to no instruction on how to make a damn bottle.

The vast majority of babies will have some formula in their first year. Heck, by the time they are 6 months old, it’s a safe bet to assume most of them are partially, if not exclusively, formula fed. We can’t sell infant feeding as the number one predictor of infant health and development and simultaneously ignore the primary way our nation’s babies are being fed.  It’s bogus, and irresponsible.

This is not to imply that parents are putting their babies in dire jeopardy because they leave a bottle out too long, or forget to scrub their hands like Lady MacBeth before mixing formula. Heck, I committed almost every formula feeding sin and my kids are pretty normal. (Except for Fearlette’s suspicious fear of police helicopters, but I blame that on her past life.) But until we ensure that parents are properly educated on formula feeding – something that could be done with one quality, AAP-endorsed pamphlet, or a few minutes of discussion in a hospital baby care class – we can’t possibly get a clear idea of the real risks of formula feeding (I bet we’d see an even smaller difference in breastfed versus formula fed if all formula feeding parents were doing it correctly), or feel confident that all of our babies are getting the best version of whatever feeding method their parents have chosen.

For now, I’d suggest checking out Bottle Babies – a great non-profit organization run by some friends of mine. They’ve put together some excellent, research-based information on a myriad of bottle-related issues. Or feel free to click on the link to the FFF Quick-and-Dirty Guide. And I hate to say it, but for the moment, the formula companies are probably the best resource for formula feeding parents. At least they give a crap about their customer base, even if this is rooted in a desire for customer loyalty and a fear of litigation.

And, ya know, remember to wash your hands.

Guest Post: Formula feeding tips – since you’ll be hard pressed to find them elsewhere

Like a good cup of tea, some ideas need a bit longer to steep. Therefore, while I try and get my next post (one that is not merely a post, but a call to action for all FFFs) to sound somewhat coherent, I’m going to share the following guest post from Firgas Esack, who wrote me a spectacular email a few months ago. I loved what she had to say, so I asked if she could elaborate. She obliged. And I am thankful she did, because I think her essay kicks ass. 

I’ll let Firgas explain her point of view, but I do want to say that I share her outrage at the lack of quality information regarding formula feeding. I’ve tried to make up for that lack of info with my FFF Quick-and-Dirty Guide to Formula Feeding, which I’ve been sloooowwwwly building over the past year or so. It sucks eggs that you need to rely on a blogger who doesn’t have an M.D. for this type of info, but I’m working on it, y’all. (The fact that there isn’t better medical advice on formula feeding, not the M.D. – although that would be cool… Dr. Fearless…. paging Dr. Fearless….oh, lay off, a girl can dream.) 

I’ll be back either tomorrow or this weekend with a new post (at this point, I’ve built it up to such a degree that it better be really good, which of course means I need to spend more time checking it for typos) but for now, sit back, relax, and enjoy the literary stylings of Firgas Esack. Oh- and speaking of a nice cup of tea, she’s British. British people like tea. Almost as much as I like cliched metaphors.

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Formula Feeding Tips- Since You’ll Be Hard Pressed to Find Them Elsewhere

by Firgas Esack

If you googled ‘Formula Feeding’ and you came to this site I’m guessing this makes you one of the following:

Category A: Like my partner and I, you’ve chosen to formula feed your child.

Category B: for whatever reason, you didn’t set out to formula feed your child but now you have to.

Category C: you are a staunch breastfeeder and are trawling the internet for someone to pick a fight with.

Now, the internet is a pretty helpful place. Over the years I have gained many a skill – from unblocking my sink to knitting legwarmers – but  (with the exception of this site) there are criminally few sources of honest-to-goodness facts, tips and advice on formula feeding – and if you fall into Category A or B this is probably what you are currently looking for.

Ditto midwives. Whilst I was pregnant I lost count of the pamphlets I was given about breastfeeding. There were cartoon ones, for the more playful would-be-BFer. There were ones that explained mastitis in plain English. Politically correct ones with multicultural mammary representation. Ones championing local volunteers who offer to visit my house and patiently show me how to put my boob into my child’s mouth correctly.

But with FF not so much. Yes, sure – the pamphlets mention the subject. As an afterthought or an appendix. Possibly with diagrams so archaic and clinical they resemble the Biology textbook which explained baby making to me in the first place. Furthermore, if a medical practitioner ‘doesn’t support’ formula feeding are they really experts to seek advice from?

I could also get some ‘information’ on the subject of FF from one of the many Mummy chatrooms out there. But try and read more than four responses into any thread and doubtless it will be crashed by a Category C person suggesting your DD or DS will be struck down with Leukaemia, live life as the class dunce or possibly grow gills as a result of consuming formula.

Even ACTUAL FORMULA BRANDS require me to tick a box before entering their website essentially declaring myself as a second class mother before reading about their product.

As I said at the top of this post, we chose to FF. But even if we hadn’t, the choice still exists as that: a choice. Yet whilst I can find plenty of guidance on how to build a bomb, roll a joint or start a cult on the interweb, I still found myself having to call up premium rate helplines advertised on the backs of formula packs – whispering into my BlackBerry so as to somehow not let on my ineptitude to my son – in order to find answers.

So – for the benefit of Category A and B readers – here are some of my FF tips based on our experiences. I’ll just add here that I live in London, UK:

  1. People will have you believe sterilizing takes a science degree to master. Sterilizing is a doddle if you get a steam sterilizer. Don’t bother with the fluid (unless you like the smell of bleach) but we recently went traveling and found those sterilizing tablets brilliantly convenient.
  2. We had no idea what brand of formula to buy. In fact, I bought every brand in the supermarket and made a spreadsheet comparing all the nutrients. But our son liked Aptamil the best, so that’s what he drinks.  And as for the cost of FF, yes – it’s not cheap. But then neither is eating mackerel and camembert daily to ensure your breastmilk is rich in Calcium and Omega 3. Nor are Pirate parties, piano lessons or the little one’s future obsession with Ben Ten for that matter.
  3. Babies are happy to drink formula at room temperature or even cold. Obviously warming bottles is ideal but you drink cold milk so why shouldn’t they? Don’t beat yourself up if it’s 2am and you can’t get the bottle warmer to work or can’t face asking the smug waiter in a restaurant to heat one up.
  4. People zealously proclaim that BF babies have sweeter smelling poop. Personally, I’m not that into sniffing baby poop so have no great desire for it to smell of candyfloss. But if your bambino’s botty is producing something that’s a strange colour (grey, green…) it’s most likely temporary and most likely caused by him working some dirt or other through his system. Dirt most likely NOT from FF but from the big wide world he’s now exposed to.
  5. With formula it is easy to get your little one onto a feeding schedule that resembles yours: breakfast, lunch, supper – and a couple of snacks. You’re unlikely to overfeed if you do this and it’s a bit more sociable for all concerned than cluster breast feeds. Category C people make a lot of noise about overfeeding: as a parent you’ll be controlling your child’s portion size for many years to come so it’s no harder with a bottle than with a bowl of ice cream. Trust your instincts.
  6. Many formula companies offer a version marketed for ‘hungrier babies’. This is a little confusing (surely all babies are hungry?) but essentially fills them up so that you can hold off weaning for longer. We found a little bit of mix and match works well: hungry food at night and regular during the day.
  7. There are various schools of thought about giving water as well as formula. Unless you live somewhere really hot (i.e. not London!) you only need an ounce or so of water per day, tops. We offered our son boiled, cooled water in a tippee cup from around 12 weeks – he controlled how much he wanted and he learned to use the cup. Interestingly on our recent traveling adventure we discovered that formula companies in warmer climates make powdered fennel tea to rehydrate FF babies – it is meant to be beneficial and it’s a nice idea to have a child that prefers herbal tea to Sunny Delight later in life.
  8. Bottles come in all sorts of shapes and many people think it is the bee’s knees to have a bottle that resembles a breast. In our experience, the cheapy, straight up and down ones you get from the chemist are easier for the baby to drink from without trapping air bubbles and therefore less likely to cause hiccups or spit up.
  9. Finally, if anyone genuinely thinks that FF reduces their ability to bond with their baby then I’d question what the heck they are doing with their little one the rest of the time. Love is expressed in so so many more ways than via the medium of lactation!

If you’re a Category C reader (and you’re still reading this) please don’t let me stop you voicing your opinion. The internet also supports freedom of speech. But my happy, smiley four month old son sleeps like a professional and thrives on formula – especially when his Daddy gives him his bottle. And (I’ve just checked) he doesn’t seem to have any gills.

 

The FFF Quick-and-Dirty Guide to Formula Feeding: Differences between formulas and bottles

I’ve promised quick and dirty, and instead I’ve delivered Ivory soap-flaked novellas, haven’t I?

Sorry about that. This “chapter” will be as short and to-the-point as I’m capable of.

Two issues I want to cover here: how to pick the right formula, and how to choose the right bottle, for your child. First the easy one….

1. Do different bottles really make a difference?

I’ve raised two primarily bottle-fed babies and yet standing in the bottle aisle still makes my head spin. There are just so many darn choices, and all of them are so… different. I am a sucker for a cool-looking design, so I went for a rather space-age looking set with my younger daughter. Come to find out that space age also means drippy and aggravating.

It really boggles the mind. Anti-colic, anti-gas, with vents and without, glass or BPA-free plastic… But just like there is no one-size-fits-all method of infant feeding, there’s no one-size-fits-all bottle. Even the one that gets the best reviews online may end up being wrong for your particular baby. That’s why it’s hard to say which bottles are the “best”; there was one interesting study conducted by one company which appeared to suggest that their bottles maintain vitamins and antioxidants better than others, but then again, nearly every big-name company claims to be “clinically proven” to lead to less colic or gas. I’d love to see a large-scale, independent study on what bottles really do offer the best health-related benefits, but I’m not aware of any at the moment.

But while we can’t say one is “best” across the board, bottles certainly do differ. Some babies prefer the shapes of certain nipples better, for example (and in fact if you are either combo-feeding or switching from the breast, studies suggest that babies prefer a nipple shape which resembles the mother’s own nipple – this is valuable info for parents of babies who do not transition well). Baby bottles also differ in how much air gets allowed into the bottle by the mechanics of the nipple (this is where all those discs, vents, rings, etc. come into play), which can definitely affect gassy or refluxy babies, at least according to moms I’ve talked to. (For the record, nothing helped my severely refluxy baby, and we tried every bottle on the market. I have a feeling these things make a difference for kids with mild reflux or who are getting gas/discomfort from feeding postures, awkward latches and so forth, but I’m not convinced a bottle can really “cure” a baby with clinical GERD.)

Other than that, bottles differ in how easy they are to clean. The more parts they have, the more aggravated you’ll be at the end of the day when you have 6 bottles to wash and just want to go watch Grey’s Anatomy.

Best advice? Don’t commit to any brand too soon. Before your baby is born, read the reviews online, and choose one to start with. ONLY BUY ONE OR TWO. Don’t make the same mistake I made with the space-age ones and fork out $50 for the 6-bottle set. (Most babies will like whatever they are first exposed to, so if you go for the cheapest BPA-free ones, more power to you.) If your baby likes the bottle you chose, go buy more. If not, try and figure out what he doesn’t like about it. Is the flow too fast? (If so, you may want to see if the company makes a slower nipple; that may solve the problem). Too big? Is the nipple too big for your baby’s mouth? Does it seem like he is swallowing a lot of air, or gulping? Or is the problem on your end – is it an awkward shape for you to hold, or is it drippy?

Sounds lame, but whatever your issue is, Google it. I guarantee you’ll stumble across Babycenter or Facebook threads discussing that very problem, complete with numerous rants and raves about bottles that address your specific concern. Buy one of the bottles you see recommended a lot, and hope for the best. It may take a few tries to find the one that works for you.

You may also want to check out my post on changing nipples and formulas as your baby grows.

2. What are the differences between formulas? Aren’t all formulas the same?

There’s this mythology out there that all formulas are the same. They are not.

Yes, all commercial formulas must meet certain nutritional standards, so all of them will nourish your child. Generics are fine, and there is no reason to pay full price for a name brand if you can get the same result from the cheaper version. But there are indeed differences between brands and types which, although sometimes small, can make a significant difference, especially to a sensitive child.

There are several categories of formula. The first are standard milk-based formulas. Within this category, some manufacturers have different formulas designed for age range – the differences in these is usually that the proteins are a little easier to digest in the newborn version, and there may be more or less of certain vitamins for different age ranges. There are also thickened formulas for reflux, which are just normal, milk-based formulas with added rice starch to help the liquid stay down; and organic versions, which typically use an organic milk source. Not all ingredients in these formulas are organic, however.

While still milk-based, the next category is comprised of “gentle” formulas marketed for babies with sensitive tummies. Depending on the brand, some are made with partially broken down proteins which are easier to digest. Recent studies have suggested that babies fed formulas with these types of protein – called partially hydrolyzed proteins – fare better in a few key ways.So they might be worth considering. You want to look for the words ‘partially hydrolyzed whey or casein” on the label – these are types of milk protein.

Next up, there’s soy formula. There is some question on whether giving babies so much soy protein is a good thing, so these are usually only recommended if a baby is truly lactose intolerant, or allergic to milk protein, or if the parents are vegan. My personal view is that like anything, these should be assessed with a risk/benefit analysis – if you can find another type of formula that works for your baby, it’s probably not worth the (incremental) risk of having her consume too much soy. But remember- this is a small, small risk, so if there are other immense benefits to using soy (for example, your child can’t tolerate milk-based formulas and you can’t afford the hypoallergenics), you can still choose it with confidence.

Then, we have hypoallergenic formulas which are made with completely hydrolyzed milk protein – meaning it’s broken down so much that even babies allergic to milk protein can tolerate it– or a prescription version for severely food allergic babies, made from amino acids rather than milk or soy proteins. These are seriously life-saving for babies with severe allergies or food intolerances, but they are quite expensive and smell pretty nasty (especially when you drip them all over your car. Not that I’d know from experience or anything…) so these should only be used if you really need them. They are also marketed for “colic symptoms”; unless the “colic” is caused by a food intolerance which is exacerbated by regular formula, they probably won’t do all that much for you. Then again, since no one really knows the cause of colic, I could be dead wrong about this. If colic is some sort of gastrointestinal issue, then a hypoallergenic (or “hydrolysate”) formula could feasibly make life easier for a stressed-out baby gastro system. It’s worth a shot. Usually, if these formulas are going to help, you’ll know withing 24-48 hours of trying them. It’s often a quick and dramatic change for the better.

Lastly there are specialty formulas – some for premature infants or infants who are having trouble gaining/maintaining weight (sometimes doctors will have parents use regular formulas and just mix up different ratios of formula to water or add other elements to make them more nutrient dense – which should ONLY be done with a doctor’s supervision), and lactose-free formulas for kids who are lactose-intolerant. Most children are reacting to the milk protein and not the lactose (although certainly not all – lactose intolerance does indeed occur in babies, it’s just not as common as milk protein allergy) and will not do any better on these formulas; they will need a hypoallergenic formula to make them more comfortable.

3. What’s the difference between ready-to-feed, concentrated, and powdered formula?

Formula can come in three forms: powder, ready-to-feed, and concentrated.

The most common and economical option is the powdered formula, where you mix specific amounts of powder with (safe) water to make the formula.

Ready-to-feed is exactly what it sounds like – the formula is ready to go as is, so all you need to do is pour it from the container into the bottle, or some companies make “nurser” bottles, where you just attach a nipple directly to the bottle the formula comes in. These are often used for newborns, due to their ease and safety – if there is no water or mixing involved, there is less chance for human error or contamination. I think if you can afford to use them, they are the best bet for the first few weeks. There’s a lot less to worry about when you’re using these, and what new parent couldn’t use a little break from all the worry?

The last kind of formula, concentrated, isn’t all that common these days, but it is kind of like condensed soup – it comes in liquid form, and you need to add water to make it drinkable.

There are actually some differences in the formula itself when in different forms – some sensitive or refluxy babies do better with ready-to-feed, for example, because it isn’t clumpy and tends to be smoother and creamier in consistency than the powdered version. Also, most powdered formulas contain anti-caking agents – often corn-derived – that certain babies might be sensitive to. But for most babies, the powdered version will work just fine, and it is certainly the most economical option.

Bottom line: formulas and bottles do differ by type, brand, etc. This doesn’t mean one is necessarily better than the other, but there are fundamental differences, so if you are having feeding problems, don’t despair. It may be a case of trial-and-error (and if you’re like me, there may be a lot of error) but eventually you will find a feeding system that makes the heavens open and the sun shine down. Well, maybe not that good, but at the very least, you’ll find a system that allows your baby to be comfortable and fed.

The FFF Quick-and-Dirty Guide to Formula Feeding: How much and how often should you feed your formula-fed baby?

There are a ton of charts and calculators online claiming to help you figure out how much you should be feeding your baby. Unfortunately, they are all missing one fundamental message: your baby is an individual. He probably doesn’t adhere to static feeding rules any more than you do. For instance, I tend to eat barely anything during the day, but I chow down like a Sumo wrestler at night. Although this runs contrary to all advice given by nutritionists (I think the breakfast like a king, lunch like a pauper, dinner like a peasant concept is pretty well-accepted across the board), this seems to work for my body and my metabolism. Likewise, there are some kids who eat more, some who eat less, some who eat a ton and then throw it all up because they have god-awful reflux, and some who comfort eat due to stomach distress. The latter two might need some medical help (or a formula switch) to remedy their issues, but my point is that not all babies play by the Baby Rulebook.

I hesitate to give a formal “guide” on how much you should feed your baby, because I believe that for the most part, parental instinct is superior to over-generalized prescriptives. But I know there’s a need for non-judgmental practical advice, so here goes.

Before talking amounts, let’s just go over some basics:

1. You cannot overfeed a newborn. You cannot make a newborn fat. Yes, I know there have been recent studies linking rapid weight gain in infants to later obesity, but come on, people… how many scrawny people do you know who were chubbilicious babies, and vice versa? Newborns do not have the brain power to binge eat. They eat when they are hungry (there is one exception to this, which I will talk about in a second, so bear with me), and when they are full, they will pull away from the bottle or, when they are teeny tiny, they may just unlatch. I’ve heard the warnings about formula feeding parents forcing their kids to finish the last few ounces while the poor babies flail and choke helplessly, but the fact is, any baby who is strong enough to to do the “breast crawl” or handle breastfeeding can make it pretty clear when they are done with a bottle. Just watch your baby – if she pulls away or suddenly doesn’t seem interested in eating, that means she’s done. Doesn’t matter that the feeding guide that came with your formula says she should be eating 3 oz in a sitting; if she acts finished after 1.7 oz, that’s all she needs at the moment. On the other hand, if she downs the 3oz you prepared and is still screaming at you or sucking desperately at the nipple, offer her another few ounces (this is where a formula pitcher or even just a salad-dressing mixer comes in handy – if you make like 10 oz at a time, you can offer smaller amounts off the bat and give only an ounce or tow more at a time, so as to avoid wasting formula.

2. As for knowing when to feed your baby, that’s a matter of learning his hunger cues. All babies have them; the most common ones are “rooting” (moving his head from side to side or opening his mouth wide like a guppy, especially when you touch his cheek or chin); shoving his hands in his mouth; sucking on whatever is in reach; crying (this is what many baby sites deem as a “too-late” hunger cue, implying that if it gets this far you must have been negligent in some way); fussing; or my favorite, sticking out his tongue.

3. As your baby gets older, hunger cues aren’t always so easy to read – babies lose the rooting reflex at a point, and sometimes it can be hard to tell what’s hunger-related fussiness versus plain old fussiness. This is where it’s easy to fall into the trap of giving a bottle for comfort and not hunger. It’s unfair, because one wonderful perk of breastfeeding is that you can pop a baby on the breast at the first cry and no one thinks anything of it; do the same with a bottle and you’ll be warned against obesity and blamed for your child’s emotional eating problem in 20 years. Fun times. Professionally, I know the right thing to say is that giving a bottle to calm a baby is probably not the best idea – in fact, I kind of think giving the breast to calm a baby would have many of the same negatives. But personally, as an ardent supporter of Path of Least Resistance Parenting, let’s just say I would never fault someone for giving a comfort bottle when their baby is screaming bloody murder in the car or whatever. Sometimes, you just need to calm the kid down, and if other things aren’t working… well, do what you need to do. As long as it isn’t a daily habit, I wouldn’t worry too much about it.

4. Okay, remember I mentioned there was an exception to the stuff I’ve been saying? That exception is if the baby has an underlying GI or health issue which may make eating challenging in any number of ways. For example, if your baby has an allergy or intolerance to formula, or severe reflux, the “classic” presentation is that she will refuse the bottle altogether, and show signs of failure to thrive. But sometimes this can manifest in what’s known as comfort feeding. Imagine that you’re a baby, and your stomach is constantly hurting or your esophagus feels like fire. And then imagine that when cool, smooth liquid is running down your throat, and you have that lovely sucking motion going on…. not all babies are going to make the association that it’s eating which is causing all the pain to begin with.

Reflux is tricky too, because some kids may eat a ton and throw up the majority of it; it might appear that they are over-eating, but really they’re keeping down the bare minimum of daily calories. Confusing matters further, kids who do eat too much for their little bellies will simply spit up the extraneous amounts; some might assume this is reflux – and a vicious cycle can begin. But I’ll tell you a little story: my Fearlette was consuming about 32 oz of thickened formula (fed in frequent, small amounts) a day. About 15 oz of that was getting regurgitated on a daily basis. She was the scrawniest baby you’ve ever seen, sometimes scarily so. But to read the “how much should they be eating” charts, you’d think I was doing everything wrong.

Bottom line? There are exceptions to every rule. I’ll say it again – every child is an individual. It’s far more helpful to focus on getting to know your kid- her quirks, her cues, her special needs – rather than knowing what the experts say you “should” be doing.

I know you’ve probably skimmed to the end of this novella and are probably wishing I’d get to the point – FFF, just shut up and tell me how much and how often should I feed my baby, dammit – so here you go. The basic rule of thumb for formula feeding:

For every pound your baby weighs, s/he should be eating approximately 2.5 oz of formula. So if she is 10 lbs, that’s 25oz per day. Most kids top off at 32 oz; the general consensus is that anything between 16-32 oz per day is in the realm of “normal” (god, I hate that word). In terms of how often, most sites/experts advise every 2-4 hours in the beginning, with longer stretches at night as the baby grows. Again using our 10-pounder as an example, this might mean five 5-oz bottles per day. But some kids are snackers, so this could also mean feeding a baby every 2-3 hours with 2-oz bottles. Just depends on the kid.

Let’s assume you have the most textbook child on the planet, though; in this case, your best bet would probably be to distribute those 25 oz primarily in daytime hours, assuming the 10- pounder is at least 8 weeks old and can go longer stretches at night. You might do a 5oz bottle at 9am; 12pm, 3pm, 6pm, and then top him off with 3 oz around 9pm to help him go through the night, with probably another 2oz around 5am. Figure out the schedule that works best for your baby; my point is just that many kids will only be able to handle a specific amount at a time, and at certain times they may want more than others. Many breastfed babies do what is called “cluster feeding”, meaning they have numerous short nursing sessions all clumped together in a short time period. Formula fed babies can do this too (obviously), by drinking smaller amounts every hour or so. (If she usually takes a 4oz bottle every 3 hours, you can do a 3-oz bottle an hour before bedtime and then another 2 right before she goes down.) Some claim that this allows babies to sleep longer stretches at night; kind of the equivalent of carbo-loading before a marathon. I did find with both my kids that if they did some cluster feeding around bedtime, they slept better. Could have been a fluke though.

During growth spurts, you may find that your typical amount isn’t enough. I think that as long as you have spent time getting to know your baby’s hunger cues, you can feel pretty safe just feeding on demand. But also keep in mind that kids can get might ornery during these growth spurts, so it is possible that they will cry a lot and it won’t necessarily mean they are hungry. Do whatever it is you do to comfort them, and if it doesn’t work, let them eat. Babies don’t play mind-games: if something else is wrong, your baby will probably keep freaking out despite your sacrificial offering of Enfamil. If she’s hungry, she’ll eat and hopefully sleep… well, you know.

Like a baby.

Whatever the hell that means.

Bottle Holding is Not Bottle Propping (and neither is the end of the world)

I won’t lie to you guys – there were many, many times in FC’s babyhood when I would have killed for a device like this. Judge all you want, but when stuck in Los Angeles traffic on the 405 and your kid is screaming in hunger and you know all he needs is a little formula…

Anyway. I never did bottle prop, but I can’t say I wasn’t tempted. And I rejoiced when he started holding his own bottle around 5 months of age; it made those long car rides exceedingly easier.

(This is one of the rare cases where I didn’t envy my breastfeeding friends, by the way. At least if Fearless Husband was driving, I could sit in the back and hold a bottle for FC. Considering you can’t take the baby out of the carseat while driving, I’m not sure there would be any way to breastfeed on the road without pulling over. In LA, this isn’t always the easiest thing to do… there are long stretches of my commute where pulling over would mean putting myself at major risk, what with being a woman alone with a baby and the violent crime statistics of the neighborhoods. Obviously not a huge problem as you can always just feed your baby before you begin your journey, but if you get stuck on the 10 freeway for two hours – a daily occurrence here – and you have a newborn in the car…. you can imagine why I felt a bit less bitter about bottle-feeding during those times.)

Now, when FC started holding his own bottle, it was pure awesomeness, because he would still let me hold him and snuggle him while he ate. It was the best of both worlds – since I didn’t need to hold his bottle, I had both hands free to play with his feet, hug him tight, or even read him a story while we cuddled.

My fearless, feisty little Fearlette is a whole other can of tomatoes, though. She started holding her own bottle around five or six months as well. Fearlette loves to be held, but only on her terms; she has to look out into the world, has to be in control. And when it comes to her bottle time, that is hers and hers alone. She can’t really be bothered to drink a whole bottle anyway (which has made the whole weaning onto sippy cup thing disgustingly easy this time around), so she’ll grab it from me, crawl or cruise away into a corner, take a few sips and throw the bottle on the floor, usually face-down (I have Stanley Steamer on speed-dial). I’ve tried in vain to make her let me hold her – waiting until she’s ravenously hungry to offer her a bottle, as if I could lure her into my arms via her gurgling stomach…. but she just wiggles her way out.

I miss those warm, snugly feeding sessions. Oh god, do I miss them. And yeah, I suppose if I were breastfeeding, I’d still have them, because she’d be forced to have physical contact with me while feeding.

But on the other hand, I get sort of a kick out of her independence. Forcing her to be close to me isn’t going to make her bond with me; if anything, it’s going to smother her. We have plenty of snuggle time, just not while she’s eating. Food and comfort do not need to be one and the same, at least after you get through the newborn stage.

Bottle holding is not bottle propping, at least in the psychological sense. You are not depriving your child of bonding time or physical proximity just because his hands are holding the food-dispensing apparatus. If he still lets you hold him while he eats, then there is no difference at all between feeding a child who does not hold the bottle and one who does. If he doesn’t want you to hold him, and has the ability to a) hold the bottle and feed himself and b) physically move away from you so that he is eating somewhere other than your arms, it’s okay to allow him this freedom. Considering no newborn on earth can feed herself, we are talking about older babies, here; ones who are learning to crawl, figuring out their own place in the world, and at least in the Fearless Chidrens’ cases, becoming their own little hard-to-please individuals. Fostering autonomy is just as important as cementing bonds that are most likely already set in stone, by the time a baby is capable of holding his own bottle.

Physiologically, however… it’s a bit of a trickier distinction. Fearlette only wants to drink her bottle lying down, flat on her back. I have no freaking clue why this is; I always held her with picture-perfect bottle-feeding posture, fancying myself a formula feeding “expert” and all: close to my chest, slightly elevated, right at boob level… the whole shebang. And yet the minute she was able, she grabbed the bottle from me, sprawled out on her back, and went to town. For months, I tried to amend this behavior, even attempting another kind of “propping” – baby propping, where I’d prop her up on some pillow so her upper body was appropriately elevated. She’d have nothing of it. It was either eat flat on her back, or not eat at all.

I was – and still am – less than thrilled about this situation. According to one anti-bottle-propping brochure from Intermountain Primary Children’s Medical Center:

If you bottlefeed your baby while she is lying flat, she will be more prone to ear infections. Your baby has little openings from the back of her throat to her ears called a Eustachian tube (pronounced you-stay-shun tube). Adults have these tubes, too, but your baby’s Eustachian tubes are shorter, wider, and flatter. When you feed your baby with a propped bottle, the liquid pools in the back of her mouth. The liquid can then back up into her ears through the Eustachian tube. This is bad because bacteria can then enter through the tube into the ear, and cause an ear infection.

This sounds plausible. I’ve said before that I believe the correlation between ear infections and formula feeding is due to the mechanics of formula feeding, not the lack of breastfeeding. I would like to have research done on babies fed breastmilk in bottles versus babies fed formula in bottles, to see if there is a significant difference in the number of ear infections between the groups. My own purely anecdotal evidence, the Fearless Family Sibling Study, found that the baby who did not insist on drinking all bottle flat on his back has had no ear infections in all three of his years on this planet, while the baby who prefers drinking while supine has had three in her not-quite-one.

And then, there’s this, from a guide for WIC professionals dealing with infant feeding:

It is not advisable to give infants a bottle (whether propped or not) while the infant is lying down at nap or bedtime or while the infant is lying or sitting in an infant car seat, carrier, stroller, infant swing, or walker. In addition to possibly causing choking and ear infections, these practices can lead to dental problems if there is milk, fruit juice, or a sweetened beverage in the bottle.

Aw, crap. Really? The highlighted part pretty much outlines the only places my daughter will drink a bottle.

But a closer look at this passage – one used to inform “professionals” about counseling bottle feeders – finds some incongruities. First of all, why does a baby holding her own bottle and drinking in a swing, carseat, etc, have more of a risk of dental problems than that of a baby whose mother is holding her during a feeding? Only one citation is used for this passage, and it is a manual from the American Dietetic Association. No studies of note.

In fact, I couldn’t find any studies specifically looking at the dangers of bottle propping or bottle holding, except for one from 1968 (oh and if anyone can get the full text of the study without paying exorbitant fees, let me know… I’d be curious to read it).

So I’m a little confused. Where is the evidence that bottle propping actually causes choking, dental disease, or ear infections? I’m not saying it doesn’t, because some of the theories and hypotheses out there sound perfectly reasonable, but until we have research, that is all they are: theories and hypothesis.

Look. The only people I actually know who bottle prop are a) daycare providers and b) moms with multiples. If I had to take care of more than two infants at one time, I’d be wanting more than just a bottle propper. (Like a bottle of Jack Daniels and some Valium.) These women are using actual bottle proppers, designed to keep the bottle at the proper angle. I would assume that this would help with the choking and ear infection risk, as long as the baby was being properly observed – not just left unattended with a propped bottle. That would be child endangerment, not poor feeding technique. I can’t see why using an apparatus that allows for hands-free feeding would be physically dangerous in the hands of a responsible adult, so the only thing left to worry about is that elusive “bonding” aspect. Considering we can’t really do a study which measures the effect of occasional bottle propping on the emotional state of infants, I’m not sure there is empirical evidence to back up these warnings.

As is the case with most infant-feeding-related stuff, these recommendations are so mucked up by the moralistic tone of parenting advice, that it’s hard to discuss them without people getting defensive or judgmental. Bottle-propping needs to be discussed and studied on a purely logistical level, as does bottle holding. Framing these recommendations as “good parents do this” and “bad parents do this” helps no one; neither do vague admonishments about ear infections, choking, and obesity; and it certainly isn’t helpful to use the two terms interchangeably.

Until I see some good, clinical research about why bottle propping is dangerous, I’d approach these recommendations a little more realistically. Yes, it’s better to hold younger babies while you feed them, if and when it is possible. If you’re a mom of six kids, or a babysitter of triplets, or in some situation where this might not be possible all the time, go ahead and prop a bottle when necessary – just do it safely. Make sure the baby is old enough and strong enough to turn away from the bottle when he’s finished, and keep a close eye on him to make sure he’s not choking (or use a slow-flow nipple – it takes like seven minutes for a drop of formula to come out of the newborn Avent nipples, for example. It’s not like buckets of formula are going to be pouring out of one of those bad boys).

As for those with older, independent bottle holders, if they let you hold them once in awhile, more power to you. Otherwise, hug, love and cuddle your kiddo in every other way possible. It’ll be okay.

Seriously, though, it will.

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