Baby food formula ratio

Bottle-Feeding (Formula) Questions

Is this your child's symptom?

• Formula and bottle-feeding questions

Topics Covered for Formula Feeding

If your baby is healthy, skip the "What to Do" section. Go directly to the topic number that relates to your question for advice:

1. Types of formulas
2. Switching formulas and milk allergies
3. Powdered versus liquid formulas
4. Whole cow's milk, 2%, 1% and skim milk
5. Vitamins and iron
6. Water to mix with the formula
7. Extra water
8. Amounts: how much per feeding?
9. Schedules or frequency of feedings
10. Length of feedings
11. Night feedings: how to eliminate?
12. Formula temperature
13. Formula storage
14. Cereals and other solids
15. Burping
16. Baby bottle tooth decay
17. Traveling
18. Nipples and bottles
19. Normal stools
20. Breast discomfort

When to Call for Bottle-Feeding (Formula) Questions

Call 911 Now

• Can't wake up
• Not moving or very weak
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Age less than 1 month old and looks or acts abnormal in any way
• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
• Will not drink or drinks very little for more than 8 hours
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Does not seem to be gaining enough weight
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Bottle-feeding question about a healthy baby

Seattle Children's Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

• Bellevue
• Everett
• Federal Way
• Seattle

Care Advice for Bottle (Formula) Feeding

1. Types of Formulas:
   • Milk-protein formulas, soy-protein formulas, and hydrolysate formulas
   • Soy formulas don't contain lactose or cow's milk protein. Currently, 20% of infants in the U.S. are fed soy formula. Often, switching to soy is not done with a valid reason.
   • Hydrolysate formulas mean the protein is broken down. These are advised when children are sensitive to both soy and milk protein.
2. Switching Formulas and Milk Allergies:
   • Switching from one milk-based formula to another is not helpful for any symptom. It is also not harmful.
   • Switching from milk formula to soy formula is sometimes helpful for severe diarrhea. This may occur from temporary low lactase levels. It may also be used for those families who are vegetarian.
   • Switching from milk formula to soy is sometimes helpful for cow's milk allergy. A cow's milk allergy occurs in 1-2% of infants. Most often, protein hydrolysate formulas (such as Alimentum) are advised. This is because 15% of these infants are also allergic to soy protein.
   • Switching formulas for frequent crying, spitting up or gas is rarely helpful.
   • Don't switch formulas without talking with your child's doctor.
3. Powdered versus Liquid Formulas:
   • Formulas come in 3 forms: powder, concentrated liquid and ready-to-feed liquid.
   • Concentrated formulas are mixed 1:1 with water.
   • Ready-to-feed formulas do not need any added water.
   • Powdered formulas are mixed 2 ounces (60 mL) of water per each level scoop of powder. Never add extra water because dilute formula can cause a seizure.
   • Powdered formula costs the least. Ready-to-feed formula costs the most.
   • Powdered formula is the easiest to use to supplement breastfeeding.
   • Ready-to-feed formula is the easiest to use for traveling.
4. Whole Cow's Milk, 1%, 2% and Skim Milk:
   • Cow's milk should not be given to babies before 12 months of age. Reason: raises risk of iron deficiency anemia.
   • Skim milk (fat free milk), 1% low fat milk or 2% milk should not be used before 2 years. Reason: the fat content of whole cow's milk (3.5%) is required. It is needed for rapid brain growth.
5. Vitamins and Iron:
   • For all infants, use a formula that has iron in it. This helps to prevent iron deficiency anemia.
   • The iron amount in iron-fortified formulas is too small to cause any symptoms. Iron in formulas does not cause constipation or diarrhea.
   • Iron-fortified formulas contain all the vitamins and minerals needed.
   • Extra vitamins are therefore not needed for infants taking formula.
   • Fluoride. Babies no longer need to take fluoride drops. Reason: the fluoride in toothpaste works very well. For children at high risk for tooth decay, your dentist may use fluoride varnish.
6. Water to Mix With the Formula:
   • Most city water supplies are safe for making 1 bottle at a time. Run the cold tap water for 1 minute. Don't use warm tap water. Reason: to avoid potential lead exposure. Heat cold water to desired temperature. Add this to powder or formula concentrate.
   • Exceptions:
     • Untested well water or
     • City water with recent contamination or
     • Developing countries with unsafe water supply or
     • Your child has decreased immunity.
     • For these conditions, use distilled water, bottled water, or filtered tap water.
     • Another option is to use city water or well water that has been boiled. Boil for 10 minutes. Add 1 extra minute per each 1,000 feet (305 meters) of elevation.
     • Bottled water costs more than distilled water.
     • If making a batch of formula, distilled, bottled or boiled water is needed.
7. Extra Water:
   • Babies less than 6 months of age should not be given any extra water. Reason: regular formula is 85% water. Also, water can cause harm at this age.
   • Infants older than 6 months of age can have some extra water. Reason: water may be needed after starting solid foods or if weather is very hot. Safe at this age.
   • Limit water for infants age 6 to 12 months: don't give more than 4 ounces (120 mL) of extra water per day. On hot days, can give up to 8 ounces (240 mL) per day (AAP).
8. Amounts - How Much Per Feeding: Newborn to 6 Months Old
   • The average amount of formula that babies take per feeding is:
   • Newborn: 1-2 ounces (30-60 mL) per feeding
   • 1 month old: 3-4 ounces (90-120 mL) per feeding
   • 2 months old: 5 ounces (150 mL) per feeding
   • 4 months old: 6 ounces (180 mL) per feeding
   • 6 months old: 7-8 ounces (210-240 mL) per feeding
   • The amount can vary depending on the baby's weight and if the baby is going through a growth spurt.
   • A baby's appetite varies throughout the day. If the infant stops feeding or loses interest, the feeding should be stopped.
   • If healthy babies are not hungry at several feedings, increase the feeding interval.
   • The most amount of formula advised per day is 32 ounces (1 liter).
   • Over-feeding can cause vomiting, diarrhea or too much weight gain.
   • If your baby needs over 32 ounces (1 liter), talk to your doctor about starting solids.
   • Get rid of any formula left in bottle at end of each feeding. Do not reuse this leftover formula. Reason: contains germs that can grow.
9. Frequency of Feedings (Schedules): Babies mainly need to be fed when they are hungry. If your baby is fussy and it's been more than 2 hours, feed him. Some guidelines are listed below:
   • From birth to 3 months of age, feed every 2 to 3 hours.
   • From 3 to 9 months of age, feed every 3 to 4 hours.
   • Infants often set their own schedule by 1 to 2 months of age.
10. Length of Feedings:
    • Feedings shouldn't take more than 20 minutes.
    • If the feeding is prolonged, check the nipple to be sure it isn't clogged.
    • A clean nipple should drip about 1 drop per second. Check this when the bottle of formula is turned upside down.
11. Night Feedings - How to Get Rid of Them:
    • Most newborns need to be fed at least twice each night.
    • Most formula-fed babies give up night feedings by 4 months of age. The tips below can help your baby sleep for longer stretches during the night:
    • Keep daytime feeding intervals to at least 2 hours. Slowly stretch them to 3 hours.
    • During daytime, your baby shouldn't sleep for more than 3 hours at a time. If your baby naps longer than that, wake him for a feeding.
    • Place your baby in the crib drowsy but awake. Don't bottle-feed or rock until asleep.
    • Make middle-of-the-night feedings brief and boring compared to daytime feedings. Don't turn on the lights or talk to your child. Feed him rather quickly.
12. Formula Temperature:
    • Most babies like formula at body temperature.
    • In the summertime, some infants prefer formula that's cooler.
    • In the wintertime, some prefer warm formula.
    • The best temperature is the one your infant prefers. Either way, there's no health risk involved.
    • Just make sure the formula is not too hot. Reason: it can burn your baby's mouth.
13. Formula Storage:
    • If you can, make your child's formula fresh for each feed. However, if formula needs to be made ahead of time:
    • Prepared formula should be stored in the refrigerator. It must be used within 24 hours.
    • Open cans of formula should also be kept in the refrigerator. They should be covered and used within 24 hours.
    • Prepared formula left at room temperature for more than 1 hour should be discarded.
    • Leftover used formula should always be tossed. Reason: contains germs that can grow.
14. Cereals and Other Solids:
    • Bottle-fed infants should be started on baby foods around 6 months of age. First baby foods can be cereals and/or fruit.
    • Starting before 6 months is not needed. Starting before 6 months makes feedings messier and longer. Early use of solids can also cause gagging.
    • Solids don't increase sleeping through the night for bottle-fed infants.
    • Delaying solids past 9 months of age is not advised. The delay runs the risk that your infant will refuse solids.
15. Burping:
    • It is not harmful if a baby doesn't burp.
    • Burping is an option, but not required.
    • It can decrease spitting up, but it doesn't lessen crying.
    • Burping can be done twice per feeding, once midway and once at the end.
    • If your baby does not burp after 1 minute of patting, it can be stopped.
16. Baby Bottle Tooth Decay:
    • Some older infants and toddlers are used to a bottle before sleeping.
    • Falling asleep with a bottle of milk or juice can cause severe tooth decay.
    • Prevent this bad habit by not using the bottle as a pacifier. Also, do not use the bottle as a security object.
    • If you cannot stop the bottles, fill it with water. Use water instead of formula or milk at bedtime.
17. Traveling:
    • Use bottles of ready-to-feed formula (most expensive).
    • Or mix formula ahead of travel and carry in a cold insulated container.
    • Or use powered formula. Put the required number of scoops in a bottle. Carry clean water in a separate bottle. Mix before each feeding.
18. Nipples and Bottles:
    • Any nipple/bottle products are fine.
    • It is not necessary to sterilize bottles or nipples. Wash them with soap and water. Rinse them thoroughly.
    • It is also safe to wash bottles and nipples in the dishwasher.
19. Formula-fed Stools, Normal:
    • Meconium Stools are dark greenish-black, thick and sticky. They normally are passed during the first 3 days of life.
    • Transitional Stools are a mix of meconium and milk stools. They are greenish-brown and looser. They are passed day 4 to 5 of life.
    • Normal Milk Stools without any meconium are seen from day 6 on.
    • Formula-fed babies pass 1 to 8 stools per day during the first week. Then it starts to slow down to 1 to 4 per day. This lasts until 2 months of age.
    • The stools are yellow in color and thick like peanut butter. Green stools are also normal (usually caused by bile).
    • After 2 months of age, most babies pass 1 or 2 stools per day. They can also pass 1 every other day. They are soft and solid.
20. Breast Discomfort in Bottle-feeding Mothers:
    • Even though you chose not to breastfeed, your breasts will make milk. Breast milk comes in on day 2 or 3. Swollen breasts can be painful for a few days. Here is what to do:
    • Ibuprofen. Take 400 mg of ibuprofen (such as Advil) 3 times per day. This will help to lessen pain and swelling. There's no special prescription medicine for this.
    • Cold Pack. Use a cold pack or ice bag wrapped in a wet cloth. Put it on your breasts for 20 minutes. Do this as often as needed. This will decrease milk production. Do not use heat. Heat will increase milk production.
    • Pumping. For moderate pain, hand express or pump off a little breast milk. This will help to reduce your pain. Pumping breast milk can increase milk production. But, doing this to take the edge off your discomfort is not harmful.
    • Bra. Wear a bra that offers good breast support or a sports bra. Wear it 24 hours a day.
    • Binding. Binding the breasts by wearing a tight bra is no longer advised. Binding by using an elastic wrap is also not advised. Binding can increase the risk of breast infections (mastitis).

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 12/31/2022

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.

How to Measure and Mix Your Baby's Formula

Written by Kara Mayer Robinson

No matter which type of formula you choose, it's important to measure and mix it properly so your baby safely gets the nutrition they need.

Why It Matters

"Measuring and reconstituting infant formula is particularly important when it concerns low-birth-weight and premature babies," says David Saltzman, MD, a Chicago-area pediatrician. A baby with an immature system may have trouble digesting formula that's not prepared correctly, he says.

Mixing formula with too much water is particularly risky. "If you dilute the formula with more water, it will contain fewer calories per ounce and not provide enough calories for your baby to thrive," says Dyan Hes, MD, of Gramercy Pediatrics in New York. It can even lead to seizures and brain damage.

How to Measure and Mix

How to prepare formula depends on which type of formula you choose:

• Powder
• Liquid concentrate
• Ready-to-feed

Powder. Most manufacturers use the same recipe: 1 level scoop of powder for every 2 fluid ounces of water.

Add powder to pre-measured water, and shake it vigorously. You can mix up one bottle at a time, or mix a full day's worth and refrigerate it.

Liquid concentrate. This dense liquid also gets mixed with water.

To fill a 2-ounce bottle, add 1 ounce of water to 1 ounce of liquid concentrate, then shake vigorously.

Mix one bottle at a time; or prepare a day or two's worth, refrigerate, and use within 48 hours.

Ready-to-Feed. Simply open and pour the ready-made formula into your baby's bottle. No measuring or mixing is necessary.

Ready-to-feed formula comes in 2-, 6-, or 8-fluid-ounce containers. Once it's opened, cover any unused formula and refrigerate it for up to 48 hours.

Whichever type you choose, be sure to follow the directions exactly.

"It is important to mix formula exactly as it is written on the container," Hes says. It's been designed to give your baby the exact nutrition he needs, and it's based on many hours of research.

The Right Temperature

The right temperature is anywhere from cool to lukewarm. If your water is safe, it's OK to mix powder with room temperature water right from your tap. Never put a bottle in the microwave, which can create hot spots that cause burns.

If you want to warm formula, here are some ways to do it safely:

• Run the bottle under very warm or hot water. A few minutes should do the trick.
• Fill a pan with hot water. Remove it from the heat. Place the bottle in the pan for a few minutes.
• Use a bottle warmer from a baby supply store.

After warming the bottle, shake it vigorously. Test it by squirting a drop on the inside of your wrist. If it's hotter than lukewarm, let it cool before giving it to baby.

How Much?

Most newborns drink about 1.5 to 3 ounces of formula every 2 to 3 hours. But this varies widely. It's normal for infants to eat different amounts at different feedings.

For premature or low-birth-weight babies, both the amount and timing of feedings vary. "It's best to consult your pediatrician with any questions," Saltzman says.

Dos and Don'ts

DON'T water formula down. You might be tempted to eke out more servings, but diluting formula is dangerous. It takes away important nutrients your baby needs and can lead to slower growth and development. It can also lead to water intoxication, which can cause seizures.

DO be clean. Wash your hands before preparing the formula. Make sure your measuring cup is spotless, too.

DON'T use water that's not safe. If you use well water or your town's supply has problems, boil the water first. Or you could choose bottled water. If you boil it, give it time to cool off before mixing it with formula.

DON'T let formula sit around. When it's mixed and ready to drink, give it to baby or store it in the refrigerator within 1 hour. Toss prepared formula that's been sitting at room temperature for more than an hour. Throw away formula your baby didn't finish.

Differences in infant formulas for children of different ages

Each formula of infant formula corresponds to a certain age of the child; manufacturers put digital markings on the packaging for identification. What is the difference between mixtures in jars numbered "1", "2" and "3", and what problems parents may face when feeding babies with mixtures that are not suitable for their age, says Polina Alexandrovna Kizino, pediatrician, consultant of the SMART project -MOTHER.

— Polina Aleksandrovna, what do the numbers on the jars of infant formula mean?

— Each age has its own nutritional needs, that is, the needs for energy and other components of a 2-month-old and a 1. 5-year-old child are different. Nutrition also changes with age:

• newborn receives only milk nutrition;
• 4-6 month old baby begins to receive complementary foods in addition to milk feeding;
• As the year progresses, the main source of nutrition will be complementary foods rather than milk or formula, although these remain in the diet. nine0014

Formulas are formulated to best meet the needs of the child at every age.

Formula jar numbers are a universal age numbering system. Typically, the line contains mixtures labeled 1 and 2 or 1, 2 and 3. The lower the number, the younger the age for which breast milk replacer is suitable.

• infant formula 1 - 0 to 6 months;
• infant formula 2 - 6 to 12 months; nine0014
• infant formula 3 - from 12 months.

If the manufacturer offers a third formula and the child continues to consume milk, then the second formula should be changed to the third at about a year.

— How to choose the right formula?

— It is important that the formula is appropriate for the age of a particular child. It is not easy for a mother to understand the composition of infant formulas and assess how they correspond to the age needs of her baby. Therefore, it is better to contact the pediatrician for the selection of the mixture. nine0007

General mandatory indicators for all formulas of infant formulas

Calories	First stage formulas are slightly more caloric, because the most intensive growth and maximum weight gain occurs in the first months of life, respectively, the need for energy in the baby is greater, than a one year old.
Proteins, fats, carbohydrates	As the child grows, the protein concentration in the formula increases, but the amount of fat decreases. The amount of carbohydrates changes slightly, but even small changes are worth paying attention to. nine0048
Vitamins, minerals	The set of minerals is approximately the same in each formula, but their concentration may be different.

- I would like to pay special attention to the protein composition of the mixture, since difficulties with its absorption often arise precisely because of milk protein. What is its danger?

- Human breast milk contains more whey protein than casein. The mixture is made on the basis of animal milk, in which the proportions of protein are different than in breast milk. And if a child is given an unadapted mixture with the same protein content as in animal milk, or whole milk, then it will be difficult for his body to cope with and digest them. Digestion problems, stool disorders will begin: part of the protein will not be absorbed due to the fact that the small organism is tuned to a different protein composition. nine0007

In order for milk protein to be well absorbed, it is adapted to the child's digestive capabilities in different months of his development. For example, whey is added to infant formula from goat milk for better protein absorption. Goat Whey provides nutrition for babies with light whey protein.

- In addition to the main components, infant formulas contain additional ones. What are these substances and what are the features of such formulas?

- Additional ingredients such as prebiotics, probiotics, DHA, lutein, L-carnitine, and others are not present in all formulas, and where present, are not always retained in formulas for older children. nine0007

In the nutrition of a small child, it is desirable to maintain continuity and move from a mixture of one stage to another with the same components in terms of saturation. That is, both there and there, for example, there should be Omega-3 and Omega-6 fatty acids, bifidobacteria, a complex of iodine, iron and calcium, and so on.

— Polina Alexandrovna, what are the features of the composition of formulas for children from birth to one year old in the line of MAMAKO® Premium infant formulas?

- First of all, look at the protein composition. The features of the first formula allow the child to take everything he needs, but without surpluses, which at best will come out undigested and affect the nature of the stool, and at worst are fraught with problems. nine0007

The protein composition of infant formula has been adapted from birth to the content of breast milk: the ratio of whey proteins to casein in it is 60:40. The total amount of protein per 100 ml of the product is reduced so as not to overload the gastrointestinal tract. There are slightly more fats in the mixtures of the first formula than in the following formulas. The content of carbohydrates, including milk sugar (lactose), also varies, but not significantly.

The second formula is for the second half of the year. It has a different ratio of protein fractions, the norms for the content of fats and carbohydrates, the dosage of the vitamin-mineral complex, depending on the needs of the child, the activity of the development of individual body systems, change. If you give such a mixture to a child of a younger age category, he may not get what he needs. nine0007

At six to eight months, milk feeding is a priority, but there are substances that the baby is already beginning to receive through complementary foods. The second formula is less adapted to the composition of breast milk, but, nevertheless, it is still modified relative to animal milk: the ratio of whey proteins to casein is 50:50. So the baby gradually gets used to the usual protein composition of dairy products, but animal milk is still beyond his strength.

When the baby is 6 months old, his needs increase, but the transition from the first formula to the second should not be abrupt. If the started can of initial formula 1 remains and the child is six months old, you can buy an adapted formula 2 and mix milk powders, gradually switching to a new product. All essential nutrients, as well as prebiotics and probiotics, ARA and DHA fatty acids, nucleotides, vitamins and minerals, the baby will receive from each formula, so do not be afraid that he will not eat enough. nine0007

— What are the features of Formula 3 infant formula for babies over one year old?

- The protein composition of the third formula is already minimally adapted and is almost the same as in animal milk. The proportions of whey and casein protein fractions are very different from the ratio of substances in breast milk and formulas for the first year of life: in animal milk it is approximately 25:75. A product with such characteristics is unfavorable for a young child, it will not be partially absorbed and may lead to individual intolerance. nine0007

If a mother chooses between whole milk and third-stage formula, it is best to choose formula. This is a special baby milk, which, unlike regular milk, is additionally enriched with the necessary amount of useful substances in the right combination and in an easily digestible form for young children.

— Do I need to consult a pediatrician when changing formula according to age?

- Pediatricians generally recommend buying the same brand, but do not abruptly stop feeding the first and switch to the second formula. It is necessary to withstand the adaptation period and smoothly introduce the mixture as a new product, despite the similarity of the composition. nine0007

The gradation of mixtures into the first, second, third formulas is extremely important in infant nutrition. It shows the degree of adaptation of the nutritional composition to the physiological needs of children at different ages: up to 6 months you need a mixture labeled 1, after 6 months - 2, after a year - 3. Do not quickly change one formula to another: in the process of a smooth transition, the child will be easier assimilate a new mixture, there will be no diarrhea, constipation or other undesirable conditions. It is also wrong to stay on the initial mixture for a long time or try the next one early - this can affect the well-being of the child. nine0007

*The ideal food for an infant is mother's milk. WHO recommends exclusive breastfeeding for the first 6 months. MAMAKO® supports this recommendation. Before introducing new foods into your baby's diet, consult with a specialist.

How to properly dilute infant formula

Properly prepare milk formula - it would seem that it is easier, read the instructions on the box and do as it is written. But sometimes the simplest things, especially when they concern a newborn, can simply put parents in a stupor. nine0007

Contents

• How to properly dilute the mixture
• How to prepare infant formula
• How long does reconstituted infant formula
keep?
• What water to dilute infant formula
• Water temperature for infant formula
• Preparing the mixture for night feeding
• Infant milk formula on the road

You should know that no formula, even the most modern adapted formula, can completely replace mother's milk. Transferring a child to artificial feeding should be a conscious and forced step, and not the advice of a friend and the desire to make life a little easier for yourself, to have freedom of movement or your own guesses and assumptions that there is not enough breast milk. The deficit that is formed in the child's body without mother's milk cannot be filled with anything. nine0005