Infant Formula 101: Pace Feeding (guest post!)

(When she learned I was doing a series on formula- and bottle-feeding, my good friend Lindsey asked if she could share what she knew about something called paced bottle feeding. It's a wildly informative post, so I'll let her take it from here. Thank you a million times over, Lindsey!)

I would like to thank Stephanie for giving me the opportunity to contribute to her blog. When I read that she was doing a series about formula and bottle feeding I was excited about the topic and asked if she would be interested in a guest article. As a mother of a child who was exclusively formula fed, I believe that accurate and honest information about formula/bottle feeding is very much needed. Many women bottle feed either by choice or circumstance, and they deserve just as much information and support as their breastfeeding counterparts. I would like to take this time to talk about a method of bottle feeding known as Paced Bottle Feeding (PBF). Surprisingly I have found very little information online about this method, and most formula/bottle feeding mothers that I know in real life have never heard of it either. I would like to introduce myself and talk about how I came to be familiar with PBF.

I am a 32 year old mother of a 2 ½ year old boy and a soon to be little girl (due in May). Like many first-time moms I had every intention to breast feed. Everyone says it's the healthiest thing for your baby, it's free and easy to do! However, after giving birth I ran into several challenges that I did not expect. I had a newborn who had no interest in latching, very little hospital support (including one downright nasty nurse who made me cry and an intimidating pediatrician) and the beginnings of postpartum depression. By the time I left the hospital my son had developed such a bottle preference that he wanted absolutely nothing to do with the breast, and would in fact scream and actively pull his head away from my breast every time it was offered. I sought the help from a local lactation consultant who came up with a plan to get my son onto the breast. However, at that point I was sleep deprived, depressed, and had no emotional or mental energy left. At just two weeks in I made the decision to switch to formula full time. Included in my Action Plan made by the lactation consultant was a sheet of paper that explained something called Paced Bottle Feeding, and I used this method with my son with a lot of success.

So what is Paced Bottle Feeding? The name pretty much explains it. It's a method of bottle feeding that allows the baby to set the pace of how she or he eats from the bottle. It follows the natural suck-swallow pattern that a baby would do if he or she were eating at the breast. One of the main criticisms I often hear about bottle feeding is that the baby just chugs down the bottle with no break, which then leads to over feeding and the inevitable regurgitation. With PBF you follow your baby's lead. They set the amount that they want to eat which can reduce overfeeding, spit ups and general upset tummies.

How does one do Paced Bottle Feeding?

Step 1: Hold your baby to an almost upright position. Newborns and small infants who do not yet have full head control will need to be assisted with head and neck support.

Step 2: Place the bottle perpendicular to the baby's mouth, and tickle the lips to see if the baby is interested. If so, insert the nipple into the baby's mouth and slowly tilt the bottle up.

Step 3: Let the baby take a few swallows (about 3-4), and then tilt the bottle back down to allow that baby to catch a break for a few seconds.

Step 4: Tilt the bottle back up and repeat the 3-4 swallows followed by a few seconds break. Continue to do this until either the baby finishes the bottle, or stops sucking and has no more interest in eating. When my son was little he would shut his lips together and move his head away. Sometimes after a bottle has been finished the baby still wants more food. That is okay! Babies are constantly growing and require more food as time goes by. Sometimes all it takes is another ounce.

So there you have it, Paced Bottle Feeding!

Infant Formula 101: Types of Formula

Like most new expectant parents, we received all sorts of formula samples, sometimes even full-sized cans, of Similac, Enfamil, and Gerber. Since I had planned on breastfeeding from the start, we put those into the cabinet and pretty much forgot about them.

That is, until my raw, bleeding, blubbering self was handed a bottle by my loving husband. The first of many bottles that Tycho would have.

We found out relatively quickly that something wasn’t working. Tycho started to get really gassy, like his stomach was cramping up, and he started getting some mucus in his stools. So we switched from what we were using (Similac Advance) to something we thought would be easier (Similac Sensitive). Matt was concerned about the amount of corn in that blend, so we switched to Enfamil Gentlease, to no avail. We also gave Nestle Good Start a try for a bit, and that seemed to work for about a month, but his issues came back with a vengeance. We thought then that it might be a milk sensitivity, so on with researching hypoallergenic formulas; we even bought a can of Enfamil Nutramigen, thinking that would work (after all, I was a Nutramigen baby). He HATED it. Like, hated with a huge, capital “H”.

We were at the end of our rope when our doctor, blessed be that man, suggested we try a soy formula. Even Nutramigen has milk proteins, albeit broken down to a point that most babies can take, but we needed something that Tycho would actually, you know... eat. So we picked up some Earth’s Best Organic Soy formula.

He ate it. All of it. And for the first time in his short life, he was happy.

And so were we.

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

As you can tell by our experience, absolutely not, not all formulas are the same. Yes, they all need to meet certain nutritional standards, including generic brands, so any formula will be a good choice for your baby. But while the differences are sometimes small, those differences between brands can make a huge difference, especially to a sensitive child.

Milk-based formula. These are the most common types of formula and can be tolerated by most babies. Some manufacturers have different formulas for different age ranges; for instance, some have different vitamins and minerals meant to supply what a growing baby needs at each stage of his life. There are also thickened formulas for reflux (typically with rice starch) and organic versions (though not all the ingredients are organic).

Gentle formula. Typically also milk-based, gentle formulas are marketed towards babies with sensitive tummies. They’re made with partially broken-down proteins, or partially hydrolyzed proteins, so they are easier to digest. They’re something to consider, as it’s suggested that babies fed this kind of formula fare better in a few different ways. You’ll be looking for the words “partially hydrolyzed whey or casein”, or broken-down types of milk proteins, on the label.

Soy formula. There’s been a lot of debate about whether soy formulas are good for babies, as it obviously floods a baby’s system with a lot of soy protein at once. These are really only recommended if baby is truly lactose intolerant or allergic to milk protein, or if the parents are vegan. We weighed the risks before putting our own baby on a soy formula, and while there are risks (incremental, I should mention), we decided that the benefits of using a soy formula far outweigh the risks that we read about. However, if you can use a different kind of formula and, say, you can’t afford hypoallergenics – or if your baby won’t eat them, like ours wouldn’t – soy is definitely an option. And it’s a good option!

Hypoallergenic formula. These are similar to the gentle blends noted above, but instead of partially breaking down the proteins, these are completely hydrolyzed milk proteins. Theoretically, it means even babies who are allergic to milk protein can tolerate it. These and the ones mentioned next are life-saving for babies with severe allergies or intolerances, but I must warn you that they’re expensive and smell like ass. Like, seriously, if I had known what I was drinking as a baby, I’d’ve refused it, too! But it’s fantastic for babies who truly need it.

Amino acid formula. Now this formula is an absolute last resort. If a hypoallergenic or soy formula fails to manage baby’s feeding issues, these formulas are designed with severe intolerances in mind. Some babies are sensitive to both milk and soy proteins, making any of the above formulas inadequate. They will still contain all the same nutrients as routine formulas, but amino acids are used instead of whole proteins, so protein allergens aren’t even a consideration.

Specialty formula. Premature infants or infants who have a difficult time gaining or maintaining their weight are sometimes put onto specialty formulas to combat these issues. This kind of formula should ONLY be used under doctor’s advice and supervision. Sometimes doctors will have parents use a regular formula and just mix different ratios of formula to water or add other ingredients to make them more nutrient-dense, but again this should ONLY be done under doctor’s advice and supervision.

Contact your doctor. That is all.

How about ready-to-feed (RTF), concentrated, and powdered formula?

Formula comes in three forms: RTF, concentrated, and powdered.

Powdered is the most common and the most economical: Simply add, shake, and stir. Safely, of course.

Concentrated is probably the least common, but it comes in liquid form and requires adding water to make it drinkable.

(Funny story: When my mom first started feeding my brother, she used a concentrated formula without realizing... and wondered why he was getting so fat!! This is definitely NOT recommended just for the fuck of it, but boy, did she feel silly when she realized what was going on!)

Ready-to-feed is exactly that: It’s already mixed and prepped for you. All you do is pour it from the container into the bottle. Some companies make “nurser” bottles where you just attach a provided nipple to the bottle of formula, making it super easy, especially for travel. They’re also great for newborns as they’re easy and safe, leaving little room for human error or contamination. Not all companies make RTF formulas, though. I know Earth’s Best doesn’t, sad!

It’s worth pointing out that some babies actually do better with RTF versus powdered formula (due to its consistency or its lacking corn as an anti-caking agent commonly found in powders), so if your baby is sensitive or refluxy, maybe try a RTF formula before switching to hypo or soy.

What if my baby has a sensitivity to his formula?

For this, I would like to point you to this post by the Fearless Formula Feeder, who does a much better job at breaking it all down. Her son had to go through myriad different formulas before landing on a hypoallergenic one, and I think she does great at explaining the signs and symptoms, when to see your doctor, and what the future holds for your hypo-baby.

Which one is best for me and baby?

Now that, you’ll need to find out on your own! One isn’t necessarily better than the other, but there are some key differences, so if there are feeding issues, don’t worry! There’s a bit of trial and error in choosing the right formula (and if you can tell, it took us a LOT of error), but you’ll soon find a feeding system that seemingly works miracles. Life will be better for everyone, trust me!

Infant Formula 101: Bottles, Bottles Everywhere! (And Nipples, Too!)

There’s a box tucked away in our sunroom. I try not to let people see it, but inevitably, someone stumbles upon it, sometimes literally, and bottles go flying everywhere. Every shape and size imaginable: Glass, plastic, lots of little parts, stupid easy bottles... we have them all.

I’ll admit it. We’re bottle-hoarders.

When we first found out we were pregnant, we registered for one type of bottle, thinking that it was the best as Amazon reviewers said so (and they’re infallible, right?): Dr. Brown’s Natural Flow. My hippie side, after learning that those bottles were pretty good, snatched up a glass set as well. Then... it ended up that Tycho didn’t like them. So we bought a set of Tommee Tippee bottles, which worked great with the dispensers we bought. Oh, and we always bought the sets, never single bottles, because “this could be it!” But nope, no-go there, either. So in came the cheapies, the pricies, and finally, finally, we settled. Tycho’s been using Playtex Nursers ever since.

Suffice it to say, there’s definitely no one-size-fits-all bottle. Even the ones with the best reviews online didn’t work for us, so is that really the “best” bottle? What if the bottle your baby prefers is nothing like you imagined it would be, does that make it “wrong”? Absolutely not!

But while there certainly isn’t a “best”, there really are a lot on the market, and they do differ. Different nipple shapes, different contraptions for purportedly reducing colic and gas, different everything. So how do you know which is best for you?

Oh, and we’re going to cover introduction of the bottle and how to feed, too. Fun times!

Selecting a Bottle

First, don’t commit to a brand too soon. This was our problem. We chose Dr. Brown’s and ended up with about sixteen bottles we no longer use, all because the reviews said they were awesome. And they are, just not for us! So read those reviews, then get one or two of that type (and others) to see what baby prefers. And go for the bigger sizes: While baby may only take a couple ounces at a time in the beginning, that will soon ramp up.

Go cheap first. Babies tend to like whatever they’re first exposed to, and if baby likes cheapies? Then so will your wallet!

Second, if baby doesn’t like that bottle, troubleshoot. What seems to be the issue? If its flow is too fast, try a slower nipple. Most bottles come with slow-flow anyway, but they do make even slower flows. Baby is sucking hard, looks frustrated, and the nipple is maybe even inverting? Experiment with a faster flow. If the nipple is too big, try one with a smaller or shorter nipple. If baby is swallowing a lot of air or gulping, make sure the bottle is being held at least at a 45-degree angle. You might need a bottle that helps reduce air flow, too.

Or it might be you! If the bottle is awkward for you to hold or seems “drippy”, either around baby’s mouth or where the nipple meets the bottle, it may be time for a switch.

When to Introduce a Bottle

If you’re formula-feeding from the start, then your answer is easy: As soon as baby is born! Some mamas decide to introduce the bottle later, though, either with breastmilk or formula, or mama may be returning to work and needs to start somewhere.

Breastfeeding? Wait at least four to six weeks before introducing a bottle so you and baby can get the hang of breastfeeding. It does take practice, and introducing a bottle too soon may lead to nipple confusion and a preference for the bottle. Any longer than six weeks, though, and baby may refuse the bottle, so if you’re returning to work, stick with the 4- to 6-week guideline.

How to Prep Bottles

Yes, there’s some preparation when it comes to the bottle itself. No matter the brand, you never want to just fill a new bottle and go. You’ll also need to wash the parts after each use – sounds brainless, but trust me, sometimes it’s forgotten!

For new bottles, sterilize all of the parts in boiling water for five minutes before first use. After the initial sterilization, hand-washing in hot, soapy water works fine. Be sure to get all the little nooks and crannies with a detail brush, especially if your bottle has several fine parts. Note that the nipple does detach from the base of most bottles, so you’ll want to separate the parts as those can get nasty real quick. Cleaning bottles in the dishwasher works, too, after the initial sterilization; you might want to look into a basket that keeps small parts contained.

All parts should be thoroughly air-dried, preferably with a bottle-drying rack. If you need to store bottles before they’re dry, wipe them dry completely with a soft cloth or paper towel.

How to Feed Baby

I really wanted to name this part “Care and Feeding of Your Bottle-Fed Baby.” Guess I kinda did. :) Anyway, so it’s mostly as simple as sticking a bottle in baby’s mouth and letting them go at it, but there are a few things to keep in mind:

Heating bottles: Most babies will take bottles at room temperature (Tycho even liked his cold on hot days!), but some prefer their meals heated. If your babe is particular, note that there’s no need to buy a warmer. Simply fill a large glass measuring cup or small saucepan with hot, not boiling, water and submerge the bottle for a minute or two. Shake gently, then test the bottle before serving.

Never EVER use a microwave to heat a bottle. Doing so can create hot spots that burn baby’s mouth, even if shaken after heating. For breastmilk, microwaving may also destroy proteins and vitamins within the milk itself.

Holding bottle: The bottle should be held at least at a 45-degree angle to prevent as much air getting to baby as possible. A good rule of thumb is to always have the nipple and neck of the bottle to always be filled with breastmilk or formula. Never ever EVER prop baby or bottle. This can lead to baby choking. Never let your baby fall asleep with the bottle in his mouth, either, or put a bottle in the crib with baby; remove the bottle if baby falls asleep.

Holding baby: Find a comfortable place to sit with your baby. You might want a nursing pillow, especially when baby is little, or a pillow propped under your arm for support. You want both of you to be comfortable!

Baby should be held in an upright position; drinking a bottle while lying down may increase the risk of ear infections and is associated with bottle caries. Switch baby either halfway through the bottle or at each feeding so baby doesn’t develop a side preference. This will also help with eye stimulation and development.

Also, I should note that you should never shove a nipple into baby’s mouth. Instead, allow baby to draw the nipple in his mouth by stroking baby’s lips to illicit a wide, open mouth. Then allow baby to accept the nipple. (This is especially handy for breastfeeding mamas, but is also respectful of baby’s eating habits and desire, too!)

Make this a real bonding time! Nurture your baby, stroke his face, hold him close, and snuggle a bit. There’s no reason why bottle-feeding should be less a bonding experience than breastfeeding.

Burping baby: Baby may need this throughout the feeding, or may wait until the middle or end of a feeding. Better to burp more often if needed! To burp baby, sit him up on your lap facing away from you, with one hand cupping his chin. You may also put him over your shoulder (my favorite). Then gently rub or pat his back for a minute or so. Baby may not burp, may give a good burp, or possibly even spit up a bit, so be sure you have a cloth over your lap or shoulder!

Enjoy It!

Feeding time is about as common an occurrence as naptime for bitty babies, and gets to be more fun (and messier!) as baby gets older, so enjoy every moment you have feeding your baby! Snuggle up nice and close, maybe talk a little, and gaze into those little eyes. Soon you’ll have a baby throwing green beans and mashed potatoes your way, so seriously... revel in this moment of quiet while you can. ;)

Infant Formula 101: Preparation

Tycho, around four months, enjoying breakfast!

Despite the fact that I breastfeed Tycho on the regular now, there are still some times when I need to supplement with a bottle of formula. Like when I was sick: That entire week, my pump output was about four ounces (or one full bottle) under what I needed to make per day, so Tycho was sent to daycare with two breastmilk bottles and one carefully prepared soy formula bottle. And y’all know that we exclusively formula-fed Tycho for a number of months, so this isn’t new territory!

When we started formula-feeding, we were a bit disappointed by how little information there was about safe formula handling. Of course, there were the instructions on the side of the can, but what about other questions? How long can I keep it in the fridge, can I mix old formula with new, can I mix breastmilk and formula? What bottle is best? What if my baby is allergic or sensitive to the formula I’m using?

Because there are so many questions, I thought I’d do a series on proper infant formula preparation. Today’s will focus on mixing bottles; others in this series will include information on bottle selection, allergies and other reactions to look out for, and frequently asked questions. I hope you find this helpful!

(Thank you to Fearless Formula Feeder for much of today's information!!)

Mixing Bottles

It may seem as simple as mixing powder and water, and to some extent, it really is. But it can sometimes be a little tricky, especially when it comes to preparing formula for a newborn, who needs special consideration and care when it comes to sterile environments and the type of water used.

As a result, these tips are split into two categories: Formula preparation for the newborn, and formula preparation for babies three months and older. Blissfully, instructions on formula prep for older babies is shorter. I’m going to include my own tips as well, as we’ve found ways to handle those 3am wake-ups without much issue!

First and foremost: Read the can you’re using. No, seriously. READ THE FREAKIN’ CAN. I tell you this for good reason. I’ll explain later why this is the case, but in short, different formulations use different types of scoops, terminology, and methodology, and you do NOT want to confuse yourself. READ THE CAN.

And WASH YOUR FREAKIN’ HANDS. Every time. No matter what.

Mixing Formula for Newborns

FIRST: Consider ready-to-feed formula for your infant. It’s safe, easy to use, and less chance of contamination as you just pour it into a bottle or use the nipple that’s provided. It is expensive, sometimes prohibitively so, but if you’re particularly worried and want to go the easier route, RTF formulas may be right for you.

If you decide to go with traditional powder formula:

1. Measure the water. No duh, right? But it’s not just about measuring correctly, it’s also about the type of water you use. For newborns, your best bet is bottled distilled water. If you don’t have any available, boil a batch of water on the stove, let it cool, and keep that in the fridge. Do not use straight tap water or even home-filtered water until baby is at least three months old.

* “Nursery water”, by the way, is typically fortified with fluoride, which may or may not be good. Check out this post from the Fearless Formula Feeder for more information on nursery water.

2. Measure the formula. And again, READ THE FREAKIN’ CAN to find out how much formula to use per number of ounces of water. Use the scoop that is provided in the can; don’t try to use different scoops, as they can vary between formula companies and even types of formula under the same company umbrella. The ratio is typically one scoop (packed or unpacked, depending on the FREAKIN’ CAN) to two ounces of water. An exception is Neocate, an amino acid-based formula, which uses one formula scoop to one ounce of water. Reading the (ahem, FREAKIN’) can... you can’t go wrong.

So yes, if you’re making a 4oz bottle, with the exception of Neocate, use two scoops; if you’re making 6oz, use three scoops; and so on. Making an odd number of ounces is a bit trickier; you can eyeball a half-scoop, but this isn’t an exact science, and I wouldn’t recommend it for a newborn. Instead, make more formula than you need, pour into separate bottles, and refrigerate the other for later use, always within 24 hours of mixing. We’ve done this a few times, especially when preparing them for daycare: We’d make 10oz of formula, shake it all up, and pour into two five-ounce servings. Voila!

3. Prepare the bottle as needed. Some are as easy as screwing on a nipple, but others – Dr. Brown’s (especially), Avent, and Born Free are a few off the top of my head – need little doo-dads to work properly. Be sure to read the pamphlets that come with each bottle for proper use.

4. Shake, shake, shake! Once all is assembled, cap the bottle or put your finger over the nipple hole, and shake vigorously. You want no clumps to remain, so you’ll really need to shake for a bit. Place the bottle on a flat surface and allow it to settle before serving. Before giving to baby, make sure there are no clumps of formula in or near the nipple; this actually happens a lot, and can block free flow to your baby.

You can also use a formula mixer/pitcher, which is supposed to mix the formula more smoothly. Since it’s recommended that you make each bottle separately right before feeding, though, and since we’re being uber-careful because we’re talking about a newborn, I’ll get to the pitcher later.

5. Feed that bottle within two hours of mixing, unless refrigerated for later use. If refrigerated, the bottle will be good for 24 hours, but anything at room temperature needs to be used within two hours. This is especially important with newborns, as bacteria can form (albeit slowly, but it happens!) and cause a lot of nasty issues, so you want to be diligent when it comes to a baby under three months.

Once the bottle touches baby’s lips, by the way, that bottle must be used within two hours, even if refrigerated. The reasoning is the bacteria issue again: There will be additional bacteria introduced once baby starts eating from the bottle, so it must be used to avoid the risk of multiplication to a point that may be dangerous. So yeah, use that bottle first!

Mixing Formula for Older Babies (3+ Months)

Told you they’re going to get shorter. :)

1. Pour the water. No need for boiled or distilled at this point, though you can certainly keep using them! Bottled, tap (so long as it’s from a safe source), or filtered water works just fine. Be sure to keep that filter up to date, though. We invested in one of the huge Brita jugs when we switched to formula.

2. Scoop the formula. As always, READ THE FREAKIN’ CAN, especially if you switched formulas recently. But the same rule usually applies as before: One scoop to two ounces of water. You can start eyeballing for odd-numbered ounces now, but I'd still recommend doubling and saving.

Now you can happily bring in a formula pitcher! This thing saved our lives when we were preparing a whole day’s worth of formula at a time. You pour in as much water as you need (in our case, we were preparing four 4oz bottles, so 16oz of water), then add as many scoops as you need (again, in our case, 8 scoops). Count out the scoops carefully, though; I’ve had to tell Matt to STFU several times while preparing, as I have had to throw out formula due to losing count of how many scoops I put in (yes, I cried over that lost milk). And of course, he sometimes made my job even harder by throwing random numbers in while I was counting. He prepared formula for a while after that. :P

We used the Dr. Brown’s formula mixer, but you can use whatever brand you fancy. And be sure to refrigerate anything you don’t use and to use whatever is in that pitcher within 24 hours.

3. Shake or mix. Still going by the individual bottle? Make sure there are no clumps or anything, same as before. Allow the bottle to settle before serving, as there may be air bubbles still left over. If you use infant gas drops like Mylicon, now is the time to add them to the bottle.

Favorite Tools

Formula dispensers! This was my favorite tip for middle-of-the-night feeds. We discovered this shortly after we needed to start formula, and it has been a lifesaver, seriously: Premeasure water into bottles, buy a formula dispenser (we used these canisters), and measure out your formula into those dispensers. When you need to feed baby, simply pour the premeasured formula into the premeasured water, shake, and serve. No more measuring while half-asleep!

This tip also works well for outings. No need to bring a cooler or anything, just the bottles and the canisters. We used this trick a lot when traveling, especially through airport security, when the last thing you need is to haul the whole can.

And of course, I already mentioned the formula mixer. Love it. Absolutely love it.

One Last Word...

While these instructions seem a bit daunting at first, I promise you, it’s really not. All this stuff becomes rote after a very short period, and soon you won’t even need to double- and triple-check the can before prepping a bottle. But there are some instances of something going wrong, and it’s typically due to improper handling that leads to issues such as bacteria and dehydration, so it’s always better safe than sorry. Read the (FREAKIN’) can, follow directions, wash your hands, and be confident! You’ll be great, I promise. :)

A very Happy New Year!!

Happy New Year, everyone! I hope 2014 is as amazing as you hope it will be! (Or, if 2013 was stellar, keep with status quo, mmm-kay?)

How did you spend your New Year? We retired early, with the babe going down at 7:30 and us following not even two hours later... so yeah, that was eventful. Maybe next year we'll stay up long enough for the ball to drop!

Tycho is already loving 2014, though!

Project Life 2014: Title Page

It's my first year doing digital Project Life, and I just have to say I'm so excited to really get good at this! I'm learning the ins and outs of Photoshop Elements, so this isn't a great title page, but it's enough to at least get started. Maybe I'll work on it more after I get started. For now, though, I'm pretty pleased by how it turned out.

The washi tape and cork letters are from my friend Melissa of A Vegas Girl at Heart, the "twenty14" card is from Dunia Designs, and the "everyday" card is from Paper Coterie. Photos are obviously mine. :) I hope you enjoy!

(Click to make bigger.)

Parenthood ain't pretty, but it sure is worthwhile.

This video makes me cry every time!