Feeding premature babies formula

Formula Feeding a Premature Infant

Parents choose to bottle-feed babies for many reasons. Here are some tips to help you be successful feeding your preemie with formula.

What kind of formula should I use?

Be sure to use the type of formula and the concentration that were prescribed when your baby was discharged. Preemie formulas and "follow-up" formulas are specially designed for premature babies. These may be better for your baby than regular formulas. With many formulas, the brand is not important but the content is. Most babies should be taking cow-milk-protein-based formula with iron. Ask your baby's healthcare provider if you have questions. Always wash your hands before preparing formula.

If using powder:

  • Follow package directions for mixing. Make sure you use the right amount of water and powder. Too much, or too little water can cause diarrhea, constipation, or other problems for your baby.

  • Try mixing with room temperature water in a blender to help dissolve the powder.

  • If you have any concerns about the safety of your water supply, use bottled water. You can check with your local health department to help determine whether your water supply is safe.

  • Use all of the powder within one month after opening the package.

  • Keep mixed formula in the refrigerator when not in use. Don’t keep mixed formula for longer than 24 hours.

  • Don't use the leftover formula from a partially finished bottle. Once a bottle of formula has been at room temperature for an hour, it needs to be discarded.

If using concentrate:

  • Follow package directions for mixing. Make sure you use the right amount of water. Too much, or too little water can cause diarrhea, constipation, or other problems for your baby.

  • Seal the package and keep it in the refrigerator after opening.

  • Use within 48 hours of opening the package.

Never heat a bottle of formula in the microwave. The liquid may heat unevenly and can burn your baby's mouth.

How do I know when my baby needs to be fed?

Preemies may not cry when they’re hungry. Instead, they may move around and become restless. Get to know your baby’s cues. If your baby is feeding less than the recommended amount, or not gaining weight on schedule, tell your baby’s healthcare provider.

Ask your healthcare provider:

  • How often should I feed my baby? ________________

  • How much should I feed my baby?

  • How much weight should my baby gain per week? _____________

Caring for bottles and other equipment

If your baby drinks from a bottle but does not finish all of the formula within 1 hour, discard the remaining liquid and give your baby a new bottle at the next feed.

Glass and metal items can be washed in a dishwasher. The following items should be hand washed in hot soapy water and rinsed in hot, clean water:

  • Bottles

  • Nipples

  • Containers

  • Brushes

How to Feed Preemie Babies

Feeding Your Premature Baby

Whether you choose to breastfeed or formula feed, meal time is an important opportunity for bonding with your baby. Here are a few tips to help you both have a successful experience.

If you choose to formula feed, ask your baby's doctor which formula is appropriate for your baby.

If you choose to breastfeed, ask your baby's doctor if supplements and vitamins are appropriate for your baby.

In This Article

About Formula | Preparing Bottles | Feeding Your Baby | How to Tell if Your Baby's Getting Enough to Eat | What You Can Learn From Her Diaper

About Formula

Ready-to-use and Concentrated Liquid infant formulas are commercially sterile in the sealed container.

Powdered infant formulas are not sterile and should not be fed to premature infants or infants who might have immune problems, unless directed and supervised by your baby's doctor.

Remember that improper hygiene, preparation, dilution, use or storage may result in severe harm.

Ask your baby's doctor which formula is appropriate for your baby.

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Preparing Bottles

  • Wash everything—bottles, nipples, and caps—in hot, soapy water before using.
  • Check with your baby's doctor about the need to use cooled, boiled water for mixing and the need to boil clean utensils, bottles, and nipples in water before use.
  • To prepare your baby's formula, make sure you follow the label directions.
  • Once prepared, infant formula can spoil quickly.
    • After opening, containers of liquid formula need to be fed immediately or covered and refrigerated and used within 48 hours.
    • Formula prepared from powder needs to be fed immediately or covered and refrigerated and used within 24 hours (check product label for specific guidelines).
  • Most babies don't seem to mind whether their bottle is warmed or straight out of the refrigerator. Some may prefer a consistent temperature from one feeding to the next.
  • If you want to warm a bottle that has been in the refrigerator, run warm tap water over the bottle or place the bottle in a pan of hot (not boiling) water. Take care that the cap and nipple do not get wet.
  • Shake the bottle occasionally while warming. The warming time should be less than 15 minutes.
  • Test the formula temperature before feeding; it should not feel warm or cold when dropped on your hand—neutral is close to body temperature (about 100°F). Warmed formula should be discarded within one hour.
  • Discard formula remaining in the bottle within one hour after feeding begins.

WARNING: Never warm formula in a microwave. Serious burns can result.

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Feeding Your Baby

Whether you're breastfeeding or bottle-feeding your baby, use these guidelines as you learn more about your baby's feeding schedule:

  • Support your baby's head during feedings, keeping it higher than her stomach. This aids in digestion and helps avoid ear infections.
  • Your baby will eat at her own pace. You'll soon recognize her pattern of swallowing and breathing. Babies who eat slowly seem to take more milk at each feeding and may be satisfied and sleep longer between feedings.
  • If your baby ever seems to have trouble catching her breath while eating, or is coughing, choking, or sputtering, sit her up until she seems ready to eat again.
  • Keep feedings relaxed, with as few interruptions as possible.
  • Keep your baby from swallowing air by keeping the bottle nipple full of formula. She shouldn't suck on an empty bottle or drain the bottle.
  • When your baby is finished eating, the nipple will fall out of her mouth and her whole body will become relaxed. Your baby will probably need about 20 to 30 minutes to finish her bottle.
  • If she seems finished after only 15 or 20 minutes, you may want to wake her and try to get her to eat for a little longer. If possible, you want her to feel full enough to be satisfied for another few hours.

Feeding Tips

  • It's important to hold the bottle at a 45-degree angle so your baby can get the right suction.
  • Your baby may need to eat on demand—or may feed well on a newborn schedule. A breastfed baby usually has 8 to 12 feedings in 24 hours, while a bottle-fed baby may have 8 to 10 feedings during that time. Whatever feeding method you choose, your baby will need small, frequent feedings around the clock.
  • You may need to wake your baby every three hours or so if she's sleeping through a feeding. Wake your baby gently by removing her blanket or stroking her arms and legs. Don't rush her or she may be too upset to eat.
  • Once she's wide awake, hold her, and touch your nipple, or the bottle nipple, to her cheek or lip. She'll be encouraged to open her mouth and turn toward it to eat.
  • If your baby takes less than 15 minutes to eat, you may want to use a nipple with a smaller hole. If she takes longer than normal and doesn't seem to be sucking actively, make sure the nipple hole isn't clogged.

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How To Tell If Your Baby's Getting Enough To Eat

  • The best way to tell if your baby's getting enough to eat is to check her growth. She should be gaining about an ounce a day during the first few weeks home from the hospital.
  • During the first few months, her doctor will carefully watch her weight gain to make sure it's increasing steadily. Also, if your baby has six or more wet diapers a day and seems happy between feedings, she's probably getting plenty to eat.
  • Your baby may give you signs when she's had enough to eat. She may fall asleep or close her mouth and turn away from her bottle. She may also bite or play with the bottle nipple, or even fuss if you keep trying to feed her. Follow your baby's lead.

If you're worried that your baby isn't eating like she should, talk with the pediatrician. If you notice any of these signs, take your baby to the doctor:

  • Constant or inconsolable crying
  • You cannot wake your baby
  • Consistent feeding refusals
  • Persistent coughing, choking, or breathing problems
  • Noticeably fewer wet or soiled diapers

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What You Can Learn From Her Diaper

Breastfed babies usually have softer, yellow stools. Formula-fed babies usually have yellow, brown, or green stools. Occasional changes in the color and consistency of stools are normal.

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