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Baby fussy while formula feeding


Bottle Feeding Your Baby: Expert Q & A

Written by Lisa Fields

From how to hold the bottle to how much to feed, new parents have many questions about feeding. Here are some answers from board-certified pediatrician Renee A. Alli, MD, a fellow of the American Academy of Pediatrics in practice in metro Atlanta.

What's the best way to choose a formula?

Your pediatrician may suggest a formula, or it may be given to you at the hospital. Unless you've talked to your pediatrician about any milk-based allergies or soy-based allergies that you or an older sibling might have, it will be a milk-based formula.

How do you know if you should change formulas?

If your baby has a rash or you see blood or mucus in your baby's diaper, tell your pediatrician. Those could be signs of a milk-protein allergy. If your baby is fussy when you're feeding them, spits up a lot, or has symptoms of reflux (arching their back, fussiness after eating, spitting up with most feedings), those may also be signs you need to change your formula.

How should you switch formulas?

If the symptoms are serious, like blood or mucous in your baby's stool, you would switch cold turkey. If it's a rash or your baby's spitting up or cranky, you can do it gradually. Your child's doctor will help you figure out a plan.

Is my baby more likely to be colicky with formula?

We don't know the reason for colic, but we know it happens in a baby's first 3 months. It can happen in both breast- and bottle-fed babies.

How much should I feed my baby at each bottle feeding?

Formula-fed babies usually drink about 2-3 ounces (60-90 ml) every 3-4 hours for their first 2 months. By 4-6 months they drink about 6 ounces and are up to a maximum of 8 ounces by the time they're 6-8 months old.

All babies drink different amounts, so check with your pediatrician during well visits to make sure your baby is gaining the right amount of weight. One tip: Wake your newborn to eat in the first month if theye sleep more than 4 hours.

How should I feed my baby?

Make sure you're holding your baby and they are not lying down. Don't prop up the bottle, and be sure the nipple is filled with milk and not air.

Mix the formula according to the directions on the can or bottle. If it's labeled "ready to feed" or "ready to use," don't dilute it.

Check that it's not too hot or cold. You don’t want to microwave bottles because hot spots can form. The best ways to heat the bottle are by running warm water over it, or you can use a bottle warmer. Or, if you're mixing up a bottle, just use warm water.

How often should I stop to burp my baby?

You may not have to interrupt your baby's bottle to burp. If your child is full-term, theye may take theirr entire bottle and then burp at the end. If your baby is premature, they may need to burp several times, and your pediatrician will likely have talked to you with advice on when and how to do it.

To burp, hold your baby upright on your shoulder or support them in a sitting position while gently rubbing or patting their back.

When should you put rice cereal in formula?

Only if your baby has been diagnosed with reflux and your pediatrician has told you to add it. Normally, you only feed rice cereal by spoon, starting when your baby is 4 months old.

Is it OK to feed a store brand of formula?

Ask your baby's doctor. They'll tell you which store brand is the same as the formula you're feeding now.

Do I have to use formula for the whole first year of life, or can I switch to milk at 9 months?

Use formula for your baby's first year. At your 1-year well-child visit, talk to your pediatrician about switching to whole milk, soy milk, or nut-based milk. Sometimes, 2% milk may be recommended in certain situations.

Bottle Feeding Problems - Why Your Baby Squirms, Appears Uncomfortable – Baby Care Advice

When your baby squirms, appears uncomfortable during a feed, fusses, cries or refuses a bottle, seemingly fights the bottle despite being hungry, it can be challenge to figure out the cause. The timing and type of behavior she exhibits provides vital clues.

Signs of bottle-feeding problems

Does your baby display troubled behavior in relation to bottle-feeding, such as….

  • Refuses a bottle
  • Turning away from the bottle.
  • Refusing to close her mouth around the nipple.
  • Holding nipple in the mouth but not sucking.
  • Taking only a small amount and then refusing more.
  • Screaming when placed into a feeding position or at the sight of the bottle.
  • Milk pouring out of baby's mouth.
  • Feeding too quickly.
  • Feeding too slowly.
  • Falling asleep before the feed is completed.
  • Coughing and spluttering when feeding.
  • Not consuming as much milk as expected.
  • Wanting more milk than expected.
  • Throwing up large amounts of milk.

Then there may be steps you can take to remedy the situation and get your baby to calmly and happily take a bottle.   

Behavioral reasons

‘Behavioral’ means baby’s behavior is in response to the circumstances rather than a physical cause. Behavioral reasons are the most common of all reasons for infant feeding problems. There are numerous behavioral reasons for a baby to experience feeding problems and/or display problematic feeding behavior. Common reasons include:

1. Misinterpreting baby's cues as signs of hunger

Does baby at times refuse feeds?

Does she take only a little and not want more?

Babies are in an oral stage of develop. Sucking is the primary way babies soothe. They also learn by sucking and mouthing objects. Many babies have a strong desire to suck for reasons that extend beyond hunger, such as tiredness, boredom, discomfort and soothing. There may be times when you mistake your baby’s desire to suck for these reasons as hunger. 

Newborn babies have an active sucking reflex. This means a newborn baby may accept a feed even when she’s not hungry, and she might guzzle down the bottle because she cannot choose to not suck when her sucking reflex is triggered. Once her sucking reflex has disappeared (usually by 3 months of age) she will willingly take only the amount she wants to take. 

If you have mistakenly interpret her fussing or desire to such as hunger and offer her a feed, she might take a little and refuse the rest, or she refuse from the start. If you try to make her drink more than she wants, she will understandably get upset and fuss, cry and pull back from the bottle. 

WHAT TO DO
  • See Hungry baby for more reasons why babies often appear
  • See Infant reflexes

2. Unrealistic expectations

Is baby not drinking as much as you expect?

Is she fussing if you try to get her to finish a bottle?

In around one third of consultations I have had with parents regarding an infant feeding problem, I found that parents were trying to make their baby drink more than he or she needed. In some cases, this was because of errors made their health professionals. They either failed to adjust calculations as baby matured or failed to consider baby as an individual.  As a result, overestimated baby’s milk requirements.

If you think your baby is not drinking enough milk (breast milk or infant formula) you’re naturally going to feel concerned. If your concern translates into trying to pressure her to drink more than she wants or needs (gently or otherwise), you’re going to upset her. So it is very important for your peace of mind and your baby’s enjoyment at feeding times that you have realistic expectations about how much she needs. 

WHAT TO DO
  • See How much milk does baby need for standard estimations for age and weight, and reason why a baby might take more or less than recommended.
  • Follow your baby's feeding cues. Don't try to make her take more when she indicates she has had enough.

3. Tiredness

Is your baby at times too tired to eat effectively?

Does she often fall asleep while feeding?

Sleeping and feeding are closely related when it comes to the needs of babies. Both are equally important to a baby's health, growth and development and feelings of wellbeing. You are no doubt aware that if your baby does not feed well she might not sleep well. But are you aware that the opposite is equally true. If she’s not getting enough sleep this has the potential to negatively impact on her feeding. 

Physical fatigue can cause baby to fuss during feeds or falling asleep before the feed is completed. If you have a hungry/tired baby on your hands, tiredness will usually win out.

WHAT TO DO
  • Ensure baby gets enough sleep.
  • Feed her before she becomes too tired.
  • Aim to establish a flexible feeding and sleep routine to minimize the risk of feeding and sleep times clashing.

If your baby is often irritable and not sleeping enough, (see Overtired baby for signs and symptoms) you might find that resolving any underlying sleeping problem will cause feeding difficulties to spontaneously resolve once she receives adequate sleep.

  • See our sleep section.
  • Download or order a paperback copy of my infant sleep book Your Sleepless Baby: The Rescue Guide. There you will find comprehensive information on the reasons and solutions to various infant sleeping problems.  

4. Distractibility

Is your baby too busy looking around or trying to play to want to feed?

Is it hard to keep her focused on feeding?

Babies over the age of 4 months can easily become distracted while feeding. They are often much more interested in the activities going on around them than they are in feeding.

WHAT TO DO

Feed your baby in a quiet environment away from noise and distractions of other children.

5. Feeding management

Some feeding problems can be related to what may appear like insignificant details but which can make feeding difficult or uncomfortable for a baby. For example, how you hold your baby will affect her ability to feed from a bottle. If her head is too far forward or too far back or her neck is twisted this can make it difficult for her to suck or swallow.

WHAT TO DO

See How to bottle-fed a baby

6. Feeding aversion

Does your baby refuse to feed even when hungry?

Does she scream at the sight of a bottle or when placed into a feeding position?

Have you resorted to trying to feed her while asleep?

A baby can develop an aversion to feeding when past feeding experiences have taught her that feeding is unpleasant, stressful or painful. Typically, baby is diagnosed with reflux and/or milk protein allergy or intolerance to explain her aversive feeding behavior. However, a behavioral feeding aversion (related to feeding management rather than a physical cause) is a far more common cause of infant feeding aversion.

A feeding aversion is the most complex of all infant feeding problems. An effective solution relies heavily on accurate identification of the cause.

WHAT TO DO

See Feeding aversion for more information. Or purchase or download a copy of 'Your Baby's Bottle-Feeding Aversion: Reasons and Solutions'.

7. Feeding equipment

Does your baby gag, cough or splutter during feed?

Does baby make clicking sounds while feeding? 

It could be the nipple is too long, too short, too fast or too slow.  

The most important piece of feeding equipment is the nipple. The nipple needs to be the right size and speed for your baby's size, age and sucking ability. If the nipple is too long, too short, too fast or too slow for your baby, she may experience feeding difficulties and express her frustration by fuss or crying.

WHAT TO DO
  • See Feeding equipment for more information on choosing a feeding nipple.
  • Experiment with nipples of different lengths, shapes and speed.

8. The nipple ring is screwed too tight

Does the nipple collapse in your baby’s mouth as she feeds?

Do you find that air rushes into the bottle once the bottle is removed from her mouth? 

It's possible her feeding difficulties could be due to the nipple ring being screwed on too tight.

In order to maintain a neutral balance in air pressure within the bottle air needs to be able to enter the bottle to replace the void left by the milk the baby is removing. If the bottle is vented, this is achieved via the venting system. However, in the case of a non-vented bottle, the only ways air can enter the bottle are between the nipple ring and the rim of the bottle and through the holes at the end of the nipple. While sucking, a baby will maintain a seal over the holes at the end of the nipple with her tongue and prevent air entry in this way. If the nipple ring is screwed down tightly this also prevents air entry. 

If air is prevented from entering the bottle, this causes a negative pressure to build in the bottle. As the pressure builds, baby need to work harder and harder to extract further milk, until such time and the air pressure is returned to normal. The effort required to suck against the negative pressure can cause a newborn baby to tire and fall asleep before completing the feed. An older baby may simply give up or express her frustration. 

WHAT TO DO

The nipple collapsing (not all will) or stopping to burp baby allows air to enter through the holes and neutralize the pressure. But you don’t want to wait for this to resolve the problem. By then baby is already tiring or getting frustrated. See ‘Collapsing nipple’ for ways to manage this problem.

9. Feeding patterns

Is your baby often take only small amounts, refuse more, but then wants to feed again an hour or two later?

Some babies develop a grazing or snacking feeding pattern where they will only drink small amounts of formula at a time and then want to be feed frequently, possibly every hour or two. Although this will not cause any problems for a baby, provided she drinks enough formula in total over a 24 hour period, it can become very tiring for parents to keep up with her constant demands for feeding.

WHAT TO DO
  • Try to encourage your baby to take as much milk as possible within 45 minutes. But don't try to make her feed if she doesn't want to. Stop sooner if she does not want to continue. 
  • Ensure baby gets plenty of sleep.
  • Avoid allowing baby to fall asleep while feeding.
  • Support your baby to extend the time between feeds, by offering a little water, a pacifier, a nap, playing with her, or taking her for a walk. Aim to encourage her to wait at least 3 hours from time you started her previous feed, but only if it's reasonable to do so without distressing her. If necessary extend the time between feeds gradually. As your baby gets used to going longer periods between feeds she will gradually take larger amounts at each feed.  

10. Excessive night feedings

Is baby feeding more often at night than you would expect?

Unless your baby was born prematurely or is very small for her age, developmentally she no longer requires feeding during the night beyond the age 6 months. If nighttime feeding continues past this age its not going to harm her but it could have a negative effect on her appetite and feeding patterns during the day.  

Your baby only needs a certain number of calories in her day (24 hours) to provide for her growth and energy needs. If after the age of 6 months she continues to receive calories from nighttime feeds this will dampen her appetite during the day and she will not need to drink as much formula during daytime feeds. You might find she is content to go for long periods of time between feeds (which is usually what would happen at night). She might fuss or refuse some of her daytime bottles when they are offered simply because she's not hungry at the time. Or she might graze during the day. 

Nighttime feeding will cause your baby no harm, so if you're happy to continue feeding her during the night there's no reason to change a thing. However, it is important that you don't expect her to consume as much milk during the day as she may have otherwise taken if she did not feed at night.  

Many babies will give up night time feedings on their own accord, but others will continue to wake and demand feeds overnight for months and possibly years while parents continue to provide feeds at night. Usually the reason babies continues to demand night feeds beyond the age of 6 months is because they have learned to rely on feeding as a way to fall asleep, or because their internal body clock gets turned around - where the baby has decreased appetite during the day because of the continued night feeds and as a consequence of small feeds during the day the baby wakes hungry during the night. Body clock problems can easily become a cyclical pattern that will continue over the long term unless parents take steps to change the situation. Healthy, thriving babies who continue to demand feedings at night beyond the age of 6 months often require guidance and support from parents to cease feeding at night and turn their body clock around to a normal day-night feeding pattern.  

WHAT TO DO

Aim to cease overnight feeds after 6 months of age. However, before attempting to do this it's important to address any feeding to sleep issues your baby might have. She would need to learn to fall asleep in a different way before you will be able to successfully encourage her to cease night feeds. 

11. Starting solids early

Have you started giving your baby solids before the age of 4 months?

Have you been advised to start solids early?

6 months is the recommended age for starting solid foods. Although a small number of babies may benefit from solids prior to this age, it's generally not recommended to start a baby on solid foods before the age of 4 months. An early start on solids has the potential to cause bottle feeding problems because solid foods may decrease the baby's appetite for milk (breast milk or formula).

WHAT TO DO
  • If your baby is less than 6 months old, either cease or reduce the amount of solids you offer to see if this helps to improve the situation.
  • See our article on starting solids.

12. Solids eaten before or between formula feeds

Do you give baby solids between or before bottle feeds?

If solids are offered prior to bottle feeds, either directly before or mid way between feeds, when it's time for your baby's bottle feed she might be feeling full from the solids, in which case she's probably not going to take much milk from her bottle. 

WHAT TO DO
  • For babies 4 - 9 months (when milk is still the most important food) offer solids 15 - 20 minutes after bottle feeds.
  • For babies 9 - 12 months (when solids are becoming increasingly more important to a baby's diet) offer solids shortly before or shortly after her bottle, whichever you find works best. Babies at this age are often down to 3 bottles per day plus 3 main meals and 1 or 2 snacks. 

13. Too much solids

Does your baby love solids so much that she would rather eat solids than drink milk?  

In these early stages of learning to eat solids (4 - 7 months) solids are not needed to add value to a baby's nutritional intake, rather they are offered primarily to provide learning experiences. The baby is exposed to new food proteins that help prime her immune system. She gets to discover new tastes and textures and become accustomed to eating from a spoon. It is at this age that babies are most willing to accept new tastes. So variety rather than quantity is what solids are about. 

Many babies, particularly very young babies, experience difficulty self-regulating their dietary intake. Some babies will continue to eat solid foods for as long their parents keep offering. Some babies will prefer eating solids compared to drinking formula. However, too much solids and not enough milk is not a balance diet for a baby. It may be necessary for parents to limit the amount of solids they offer in order to encourage their baby to have a greater appetite for milk feeds.

WHAT TO DO

See our article on estimating how much milk your baby needs to make sure she's getting enough.

14. Weaning difficulties

Does your breastfed baby refuse bottle-feeds?

Does your baby have a breast preference?

While some breastfed babies willing accept milk from a bottle many will not, at least not straight away.

Difficulty weaning from breast to bottle is rarely resolved by finding the 'right' feeding nipple. (All feeding nipples will feel equally foreign to a breastfed baby.) Nor does a solution lie in finding a formula with the 'right' taste. All formula will taste strange to a breastfed baby). The difficulty associated with weaning to a bottle most often lies in the fact that bottle-feeding requires a very different sucking action to breastfeeding. While breastfeeding the movement of your baby's tongue milks the breast, where as bottle-feeding requires a sucking action. A baby who has been exclusively breastfed beyond the age of 3 months will often refuse milk from a bottle because it "doesn't feel right" and she doesn't know how to suck from a bottle.

It takes time and practice before a breastfed baby learns how to suck on a bottle. 

WHAT TO DO
  • Try offering expressed breast milk in a bottle initially. (Don't be too optimistic and put too much in to start with. It would be a shame to waste it).
  • A soft flexible nipple often works better.

NOTE: Many breast fed babies will refuse to accept a bottle while they are still being breastfed at times. They will simply wait until a breastfeed is offered.  For these babies it will be the case of breastfeeding or bottle-feeding, but not both.

How we can help your baby take a bottle
  • Your Baby's Bottle-feeding Aversion book
  • Baby Care Advice consultation
  • Rowena Bennett's Online Bottle-Feeding Aversion Program

‘Your Baby's Bottle-Feeding Aversion’ book

In my book, ‘Your baby’s Bottle-feeding Aversion’, I have described physical and behavioral reasons for babies to develop an aversion to bottle-feeding. How to identify the cause and the solutions to match. Included are step-by-step instructions on how to regain your baby’s trust and resolve a feeding aversion caused or reinforced by repeated pressure to feed.

While the book was written for bottle-fed babies, many nursing mothers have found that applying the same strategies has also helped them to successfully resolve a breastfeeding aversion.

You might find that reading this book is all you need to do to understand the steps you need to take to resolve your baby’s feeding aversion and get him back to the point of enjoying eating until satisfied. 

Baby Care Advice Consultations

If you would like an individualized assessment of all reasons for infant feeding problems, not just feeding aversion, we also provide a consultation service. Baby Care Advice consultants have extensive experience in pinpointing the cause of feeding aversion and other behavioral feeding problems such as those related to equipment and the parent’s feeding practices. (For more on what’s included in a consultation).

By Rowena Bennett, RN, RM, CHN, MHN, IBCLC.

Copyright www.babycareadvice.com 2021. All rights reserved. Permission from the author must be obtained to reproduce all or any part of this article.

Rowena's Online Bottle-Feeding Aversion Program

Six time-saving modules to help your family enjoy feeding again with Rowena's step-by-step plan. Enjoy additional tools to manage anxiety, troubleshoot any issues, introduce new carers, how to manage illness/teething and much more.

  • Module 1: Understanding feeding aversions
  • Module 2: Identify the cause
  • Module 3: Prepare for success
  • Module 4: How to resolve your baby's bottle-feeding aversion
  • Module 5: What to expect
  • Module 6: Troubleshooting
  • BONUS: Guided meditations

why the baby cries while feeding

While the baby is quite a baby, crying is the only way of his communication with his mother and the outside world. If the baby is restless during feeding, he will let you know that he is uncomfortable. We will analyze what can cause baby crying in such a situation.

Dry milk drink "Baby milk" Valio Baby 3 NutriValio for feeding children over 12 months Read more

As a rule, the causes of a baby’s tears at the breast or bottle with a mixture are physiological, and there may be several of them.

Abdominal pain

Most likely, the child is worried about colic (they can start from 2-4 weeks of age and usually end by 3 months). Unpleasant sensations are associated with the fact that the infant has an insufficiently developed intestinal microflora and it is difficult for the digestive system to cope with the task assigned to it. Children's crying during colic is accompanied by arching the back and pulling the legs to the stomach - the pain from the formation of gases in the intestines is always acute. To alleviate the condition of the crumbs, it is useful for a nursing mother to drink teas with fennel, cumin or anise. If your baby is formula-fed, choose formula carefully. Valio Baby baby food is as close as possible to the composition of breast milk and contains the GOS prebiotic, which is necessary for the health of the child's digestive system. The cause of colic is also the wrong feeding technique and, as a result, the capture of excess air by the baby. nine0003

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Earache

Children under one year old often suffer from otitis media, this is due to the anatomical features of the structure of the nasopharynx in babies in the first months of life. A baby may cry during feeding because swallowing causes a sharp pain in his ears. Very carefully touch the tragus of the baby's auricles - if he cries, then you need to see a doctor.

nine0002 Headache

It is no secret that many neurological disorders are accompanied by headaches. It becomes especially strong when swallowing. If the baby is constantly crying during feeding, be sure to make an appointment with a pediatric neurologist.

Inflammation of the oral mucosa

Crying during feeding may signal that the baby is experiencing discomfort in the mouth or throat. Its cause is most often thrush or pharyngitis. These diseases require treatment under the supervision of a pediatrician. nine0003

Lack or excess of breast milk

The lactation of a nursing woman is affected by a considerable number of factors - the psychological state, fatigue, stress, malnutrition and its lack, improper organization of breastfeeding. The baby may cry because he does not have enough milk. Whether the food shortage is really critical is easy to check using the wet diaper method. By the way, the crying of a baby may also indicate that there is too much milk - the stream is too strong and the baby simply chokes. nine0003

Unusual taste of breast milk

If a mother ate, for example, something spicy on the eve of feeding, this will certainly affect the taste of milk. The baby, of course, will cry. This cause of children's "grief" is the most easily eliminated - be attentive to your menu and do not upset your beloved baby.

In addition to the reasons described, the reason for children's tears during feeding can be erupting teeth and inflammation of the gums, as well as nasal congestion with allergies and SARS. Be attentive to your baby. If all is well, the baby should not cry while feeding. nine0003

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