Safe Formula Feeding: The Do's and Don'ts Every Parent Must Know

The key is to know that formula is not a substitute for breast milk. However, if you must, here's are some of the most important safe formula feeding practices.

Most new mums are able to make enough breastmilk to nourish their baby. Proper support and information are the keys to achieve this. But if you are unable to produce milk and your baby is not gaining weight, then perhaps it’s time to adopt safe formula feeding practices. 

Baby formula can be useful to allow mothers to supplement their breast milk. It is especially helpful for those who are low on supply or planning to get back to work. 

You’ve probably heard that formula isn’t the perfect milk that breast milk is, and you have lots of questions.

What’s the difference between breastmilk and formula milk? Should you switch over to formula completely or use it only as a supplement to breast milk? How safe is formula? How do you prepare it hygienically? 

We’ve got you covered. In this article, we’ll discuss some frequently asked questions and concerns about safe formula feeding.

Safe formula feeding: All you need to know 

You may know that your baby needs to be exclusively breastfed for at least six months. In fact, the World Health Organisation (WHO) has the following guidelines for all new mums: 

  • Initiate breastfeeding within the first hour of birth.
  • Exclusively breastfeed the baby. Give the infant only breast milk “without any additional food or drink, not even water.” 
  • Breastfeed your baby on demand. Do this as often as the child wants, during the day as well as the night.
  • Do not use bottles or teats or even pacifiers for the first six months.

It’s important to note that biologically, your baby will need only breast milk for this time (until they start solids). So the need to top up their feed with formula is only necessary in special cases, and as identified by a paediatrician. 

What is the difference between breast milk and formula? 

If you are considering safe formula feeding, then it’s a good idea to know the difference between breast milk and formula. 

Breast milk is natural, safe and a complete food that is made fresh from the mother’s body. It contains immunity boosters and livings cells that help the baby fight infections. Breast milk also provides adequate calories for the baby’s growth. In addition, it includes friendly bacteria as well as enzymes that strengthen the baby’s gut and digestion. 

In comparison, formula is synthetic processed food that has a shelf-life. It doesn’t have any living cells to protect your baby from infections. Nor does it have any digestive enzymes. So basically, it is missing these key ingredients needed for proper growth and development of the child.

Not to forget, they are made differently. You will find various options in the market. These include ready-to-use liquid formula, low allergen formula, cow’s milk formula, goat’s milk formula and even soy-based formula and home-made formula.

Now let’s take a look at the nutritional value of the two. This is what makes the real difference. 
Nutrient factors Breast milk  Baby formula What you must know
Fats
  • Breast milk is rich in Omega3 fatty acids including Docosahexaenoic acid (DHA) and arachidonic acid (AA).
  • Breast milk adjusts to baby’s needs. Fatty acid levels decrease as the baby grows older. 
  • It gets completely absorbed by the baby’s body.
  • It’s rich in cholesterol, and provides energy to the growing baby.
  • Breast milk also contains the enzyme lipase, which digests fat.
  • Formula contains no DHA and AA.
  • It does not adjust to baby’s needs.
  • It doesn’t get completely absorbed by the baby. 
  • And it’s not rich in cholesterol. 
  • Formula does not contain lipase for digestion of fat.
  • Fatty acids are brain-building and crucial in the initial months of a newborn’s life.  
  • DHA, AA and cholesterol are vital nutrients that aide in the growth and development of the baby.
  • In their absence, the infant lacks immunity and may be predisposed to heart and central nervous system problems.
  • Absence of lipase in formula-fed babies could lead to unpleasant smell in stools as the fat isn’t digested properly by the body. 
 Protein
  • Breast milk has two types of proteins: casein and whey.
  • Proteins in breast milk are completely absorbed by the baby
  • Protein levels are higher in the breast milk of mothers who deliver premature babies.
  • Breast milk proteins are soft and easily-digestible whey proteins.  
  • Breast milk contains lactoferrin. This improves digestive health.
  • Breast milk contains the antimicrobial lysozyme
  • It is rich in brain-building and body-building proteins.
  • It also contains some sleep-inducing proteins, making it easier for the baby to doze off. 
  • Formula contains casein proteins that are not easy to digest.
  • Baby cannot completely absorb proteins from formula and it leads to more production of waste.
  • It is also harder on the baby’s kidneys.
  • Formula does not contain lactoferrin or lysozyme.
  • It does not have any growth enzymes. 
  • It also has no sleep-inducing proteins.

 
  • Formula milk proteins can cause allergies in some infants.
  • Breast milk proteins do not cause allergies.
Carbohydrates 
  • Breast milk is rich in lactose, a disaccharide which is a sugar made up of galactose and glucose.
  • It is rich in oligosaccharides, which help in cell recognition and binding. These aide intestinal health. 
  • Formula has low or no lactose.
  • There is a deficiency of oligosaccharides.
  • Carbohydrates like lactose oligosaccharides are needed for baby’s growth and development. These are missing from baby formula.
Immune Boosters
  • Breast milk provides red blood cells to the baby in millions during each feed. 
  • Breast milk is also rich in immunoglobins.
  • Formula has no living white blood cells and therefore, provides less immunity to the baby. 
  • It has very few immunoglobins or is absent. 
  • If a germ attacks the mother, she can make antibodies and pass them to her baby. This helps the baby gain immunity boosters. 
Vitamins and Minerals
  • Breast milk also contains various vitamins and minerals including iron, zinc and calcium.
  • Iron, zinc and calcium are easily absorbed by the baby’s body, with iron almost 75 percent absorbed. 
  • Breast milk also contains the antioxidant selenium.  
  • Baby formula does not contain high levels of vitamins and minerals, as compared to breast milk.  
  • Iron is only absorbed by five to seven percent by the baby. 
  • Most baby formulas barely contain selenium. 

 
  • Vitamins and minerals present in the breast milk are easily absorbed by the baby.
  • Since formula is not so rich in absorbable nutrients, more is added to compensate. But this makes the formula heavy and difficult to digest.
Enzymes and Hormones
  • Digestive enzymes are needed to keep the digestive system going and break down food. Breast milk contains two crucial digestive enzymes, lipase and amylase.
  • Breast milk is also rich in hormones including prolactin, oxytocin, and thyroid among others.
  • Enzymes and hormones might differ in different mothers.
  • Excessive processing to produce baby formula can kill any digestive enzymes. 
  • Formula contains no hormones
  • Baby formula tastes the same each time and can get boring for the baby. 

 
  • Digestive enzymes aide digestive growth and development in the baby.
  • Hormones are also key factors that help with growth and development. 
  • Absence of hormones and enzymes can stunt the baby’s growth.
  • The baby is able to enjoy different tastes through breast milk.
 Cost
  •  Free
  • Click here to get a comprehensive look at the cost of baby formula in Singapore.
  

Despite the obvious disparity between breast milk and baby formula, many new mums top up their breast milk feeds with formula. This could be due to low breast milk supply. Let’s take a look at what happens when you do that. 

What happens when you top up breast milk with formula?

 1.  Imbalance of friendly bacteria 

The friendly bacteria or microbiome in your baby’s gut changes from super compatible bifidus flora (bifidobacteria and lactobacilli) into the less desirable strains. These strains are usually present in an adult’s gas. And this, in turn, reduces any protection against possible infections. 

2. Less protection from allergies 

In some babies, formula leads to milk allergies because it cannot provide additional immunity to the baby’s body.

Your baby could also be at an increased risk of developing type 1 and 2 diabetes (due to the sugar in the formula).

However, recent studies have proved that formula made from cow’s milk does not put the baby at risk of diabetes. 

3. Your baby may prefer the bottle 

Feeding formula might push your baby to like bottles. If he finds that the bottle keeps him well-fed and not the breast, then, naturally, he will prefer the bottle. 

In addition, if there is nipple confusion or if the mother is trying to breastfeed again, formula feeding may defeat your efforts as the baby will go for the bottle.
 
Finally if  sucking from a bottle at night becomes a habit for your baby, this can lead to tooth decay. 

4. Low milk supply

Your body is an amazing thing, and it knows how much milk your baby needs. So each time you give your baby a breast milk supplement, your breasts reduce milk production automatically.

When your baby automatically prefers the bottle, your breast milk supply might go down.  

Safe formula feeding practices can still help you maintain a balance between helping your child grow and giving him the right immunity boosters. For that purpose, you may need to bear a few crucial things in mind.  

Let’s start with the amount of breast milk your baby should be drinking. Ideally, you will notice the following breast milk consumption pattern in your baby:

  • Newborn. A newborn baby drinks about 1.5-3 ounces (45ml-90ml) every two to three hours. This amount will increase as your baby grows.
  • At two months. At this age, your baby should start consuming 4-5 ounces (120ml-150ml) of breast milk at each feed. These feeds will now be three to four hours apart. 
  • At four months. By this month your baby will start consuming 4-8 ounces (120ml-180ml) of breast milk in each feed. You may have to figure out when your baby demands milk and feed him accordingly. 
  • At six months. By this stage, your baby will take 6-8 ounces (180ml-230ml) of breast milk in each feed. This amount may go down if you introduce solids or formula. 

Low milk supply could be one of the biggest reasons to push you to add formula to your baby’s breast milk diet. | Image courtesy: Dreamstime

In the likelihood that the baby is unable to get enough milk at any of these four stages, then safe formula feeding practices come into play.

Keep in mind that you shouldn’t just top up your feed with formula because you ‘think’ your baby is not getting enough milk.

There are certain clear signs that indicate low breast milk supply.

How to know if your baby is not getting enough milk

Low milk supply is often the biggest reason to push you to add formula to your baby’s diet. Normally, low supply could be the result of a combination of things you might be doing.

As mentioned in a previous article, you could be managing breastfeeding incorrectly, or perhaps your baby is not able to latch properly. Here are a few things that might be working against you. 

  • Delayed lactation. Most of the time when milk comes in late, it worries the new mother. This stress may reduce the flow and speed of milk let down. And the cycle continues.
  • Supplement feeding. If you have been topping your feed with formula, chances are you are slowing down your milk supply. Every time you give your baby a supplement, your breasts reduce milk production.
  • Baby has a poor latch. Be sure to try different breastfeeding postures to help your baby get a proper latch. You must check with your lactation consultant to see which nursing position allows your baby to get a deep latch.
  • Unusual breast anatomy. One of the reasons for low milk supply may be because of your own anatomy. You could have inverted nipples, flat nipples, or very long, large and differently-shaped nipples. 
  • Hormonal disorders. Any endocrine or hormonal disorders can also cause low milk supply. Also, if you needed a fertility treatment or you have suffered from hormonal issues, it can lead to problems in milk production.
  • Insufficient glandular tissue. Another probable cause for low milk supply is insufficient glandular tissue (IGT). This condition is sometimes called primary lactation failure, hypoplastic breasts, or failed lactogenesis. 
  • Baby is not gaining weight. Your baby will go through up to seven percent weight loss during his first week post birth. But if your baby is not gaining weight at all, even after two months, he may need some more food. This is where safe formula feeding comes into play. Unless he is given an adequate amount of food, he will remain drowsy, irritated, dehydrated and unresponsive. 

Before you jump in and give your baby formula, try natural ways to increase your breast milk. 

You can increase milk supply naturally by including galactagogues (breastmilk boosters) in your diet. | Image courtesy: Pixabay

How to naturally increase breast milk supply  

Milk production often works on the demand and supply principle. When your baby demands milk, your body will produce milk to fulfill his need. However, sometimes your body needs an extra push in order to produce enough milk to sustain your baby’s demand. 

So you can try the following.

  • Milk boosters. You can increase milk supply naturally by including galactagogues (breastmilk boosters) in your diet. These include fenugreek seeds, herbal tea, nuts like almonds and walnuts, and dried figs. Lactation cookies also contain many of these galactagogues.
  • Pumping. You may have to start pumping using an electric breast pump. A manual breast pump may not be up for the job. Ideally, you should pump every three hours and even during the night. So pump for five to six minutes on a low to medium setting on the pump. Then, follow it up with a breast massage. Afterwards, pump for five to six minutes again.
  • Donor breast milk. When none of these natural ways work, you can try donor breast milk.

If all of these efforts don’t work out for you, you can resort to formula feeding your baby. In fact, you will be better advised to start formula in between trying these methods. You don’t want to keep your baby hungry.

By now we’ve established that formula should be your last resort because it is not as nutritious as breast milk. However, your baby can still thrive on formula. 

Make sure that you practice safe formula feeding by storing the mixture in the fridge. And discard the formula after 24 hours. | Image courtesy: Dreamstime

6 Do’s and don’ts of safe formula feeding 

1. Do check the powdered formula

Make sure that the type of formula milk you select is right for your baby’s age. If you have a premature baby, then stick to the doctor’s advice.

Also, remember to check the expiration date on the formula. As mentioned earlier, formula has a shelf-life. So the one you purchase should not be past the expiration date. Always check if it is properly sealed. This is a crucial safe formula feeding practice. 

2. Do focus on cleanliness 

Another important safe formula feeding practice is to focus on the cleanliness of baby’s bottles.

Before you prepare the formula, make sure to wash your hands properly and maintain hygiene in the area of preparation. Keep the can of formula clean as well. Wash its lid and its outside area before you open it. 

Most of all, whenever you open the can watch out for any foreign particles like glass or hair. 

Also make sure you wash baby bottles properly. Sterilise and clean them before you use them to fill formula. Read here to know more about how to wash baby bottles. 

3. Do measure and mix properly 

You may be a great cook, but this is not the time to experiment. Make sure to measure the formula and water ratio properly before creating a mixture. Follow the instructions given on the can or consult with your doctor to understand the exact amount of each ingredient you need. 

Also, make sure that the water you use does not go below 70 degrees Celsius to avoid any bacteria build up. This is another crucial safe formula feeding practice.   

4. Do store the formula properly 

Make sure that you practice safe formula feeding by storing any left-over made-up formula in the fridge. However, remember not to freeze the formula.

In case you are traveling, you may keep the mixture in a cooler or refrigerator to prevent it from going bad.  

Discard all milk after 24 hours.

When storing formula milk, place the can in a cool and dry place, ensuring that the lid is firmly closed. 

When you are feeding your baby, make sure to hold him closely and help him drink the formula through the bottle. This is also a safe formula feeding practice. 

5. Don’t warm the bottle in a microwave 

Please refrain from using the microwave as a way to warm the formula. This creates some hot pockets in the milk and can potentially burn your baby’s mouth. 

A better way to warm the milk is to run warm or hot water over the bottle. Or you can place the bottle in a hot water container. This a safe formula feeding practice. 

6. Don’t try to force the entire bottle 

If your baby shows signs of being full, do not try to force him to finish the entire bottle. This can lead to excessive weight gain. Furthermore, give him only as much as he needs because formula is simply a supplement for breast milk. 

A little extra breast milk will not harm your baby, but extra formula can play around with his growth. 

Remember that while many kids do need formula, you should weigh in all possibilities before you begin. If you are able to produce enough milk to keep your baby well-fed, there is no need for formula.

However, if your doctor recommends that your baby needs formula to gain weight or if you are unable to meet his demand for food, then you should go ahead.

The key is to know that formula is not a substitute for breast milk. In fact, nothing is a substitute for breast milk. But if you need the help of formula, do not hesitate. Upon consultation, include it in your baby diet so he grows up healthy and develops normally. 

Sources: Breastfeeding Support, Today’s Parent, American Academy of Pediatrics, Dr Sears  

Also read: How much formula does your baby need?

Written by

Deepshikha Punj