Is My Newborn Getting Enough to Eat? Part 2: Bottle-Feeding
In our last blog, we talked about knowing if a newborn was getting enough to eat, specifically breastfed babies.
In this blog, we will be addressing the same question for families who bottle feed, either with breastmilk or formula. Some information will be similar to what is found in our previous blog, but there are several differences that should be noted here. The information here is helpful both to parents who bottle feed full-time, and part-time.
How Much Can My Baby Eat?
Just as the baby who is fed at his mother’s breast, a bottle-fed infant will start out with a very tiny stomach that will grow, and hold more milk/formula, as she gets older.
If you plan to supplement or formula feed from the very beginning, it’s very important to know that your baby will not need very much at all in those first few days. Even the smallest bottles given at hospitals will likely hold much more liquid than a newborn can comfortably eat in one feeding.
How Often Should My Baby Eat? Despite the fact that they have yet to learn to speak verbally, babies are very good at communicating their needs to us. Your baby will tell you when it’s time to eat by giving you hunger cues. (To avoid a fussy or inconsolable baby, it’s best to tend to her hunger cues as soon as you notice them.)
If you are bottle-feeding your baby breastmilk, the same “every 2-3 hours or 10-12 feedings per day” general rule of thumb will apply to how frequently your baby will likely need to eat.
If your baby is receiving formula, however, the frequency of feedings may be closer to every 3-4 hours, due to the fact that formula isn’t digested as quickly as breastmilk, and so more time is needed for formula to work its way through her digestive system.
How Do I Know If My Baby Is Getting Enough?
Many parents mistake bottle-feeding as a more accurate way to tell how much milk their baby is getting; while it’s easier to know what amounts have been prepared and given, what’s lost through dribbles and spit-up can be difficult to measure. And since several of the traditional bottle-feeding practices are less than ideal for a baby’s comfort or ease, the amount of milk/formula going in alone is not the best way to determine your newborn’s success or satisfaction with feeding.
Like babies who are nursed at the breast, bottle-fed babies should show two things to ensure that he is getting enough to eat:
Adequate wet/dirty diapers (5-6/day and 3-4/day, respectively, in the first month)
Weight gain (an average of 6 ounces a week)
But something that trips up a lot of bottle-feeding parents is the fact that many babies, even after a full feeding, will eat more if more is given. This leads parents wondering, "Is he really getting enough? He must be famished!"
This can be especially worrisome for parents who are exclusively pumping breastmilk, or breastfeeding/bottle-feeding part-time, because the thought turns to, “I am not making enough milk to meet his needs!”
So what’s really going on with these babies who guzzle down their bottles?
Newborns come made with a sucking reflex. As noted in our last blog, it would be very difficult to force a baby with a full belly to latch onto soft breast tissue; however, it’s very easy to force a rubber nipple into a baby’s mouth, even when he’s not hungry.
Furthermore, even the slowest-flow nipple will drip when filled with milk or formula. So even if a baby is full, when liquid is dripping from the nipple he can’t help but suck on, he swallows by default. And in order to protect his airway and not choke on the next gulp, he’ll swallow again after that.. and after that...and after that…
So in addition to paying attention to your baby’s hunger cues, there are a few other things to watch for when bottle-feeding your little one:
Latch: Bottle nipples come in all different shapes and sizes - and even amongst siblings, not every baby will take or respond well to the same nipple. Just as with breastfed babies, a good latch is the first step to ensuring a good feeding. The right bottle nipple - and the right latch - will display the same things in a baby at the breast: the whole nipple in an open mouth with flanged lips, an organized body (baby’s hands by her face), and eye interaction between the caregiver and baby.
Flow: Bottle nipples also come at varying flow rates - and even the slowest flows are often still faster than milk from the breast. The flow through a bottle nipple effect’s baby’s latch - if he is using his tongue to block the milk flow into his mouth and is dribbling, try offering the bottle again at a different angle; or try a different nipple if he still seems to struggle accepting the bottle after changing positions.
Body Movements: Watch for baby’s reactions/behavior during a feeding. Is she displaying splayed fingers and/or toes? Is she turning her head away from the bottle or dribbling milk out of the side of her mouth? These are signs that baby is stressed and either doesn’t want to eat or is struggling through the feeding.
Probably one of the most common bottle-feeding practices used, whether the bottle is filled with breastmilk or formula, is holding baby at a near-flat (horizontal) angle, with the bottle tipped up high, and having baby drink the entire volume with no or very few pauses.
While this certainly makes for a much faster feeding (and therefore, more convenient for the caregiver), it doesn’t always make for a very happy or comfortable baby.
The idea behind paced bottle-feeding is to mimic the natural feeding rhythm found at the breast.
The basics include:
1) holding your baby in an upright position (enough so that the bottle is held horizontal to the floor)
2) feeding your baby very small amounts at a time with pauses in between to allow her stomach to gauge how much milk or formula it can comfortably hold.
The nipple is never taken out of the baby’s mouth during paced bottle-feeding, but rather tipped upward against the roof of baby’s mouth to interrupt the flow of liquid until she signals that she would like more (by continuing to suck). When she no longer re-engages after a break, she is finished!
Remember: spitting up isn’t the only indicator that your baby is getting too much to eat.
We adults don’t vomit every time we overeat, but it doesn’t mean we don’t feel terrible when we do! Many overfed babies will display their discomfort in other ways other than spitting up, including showing signs of colic, overall fussiness, or wheezing/difficulty breathing during a feeding.
Again, look for hunger cues and the signs listed above to ensure a satiated baby.
Never force a baby to finish a bottle; let her decide when she’s done.
Bottle-feeding takes a lot of dedication - from buying supplies and formula, to taking time to prepare and clean bottles on top of the time to feed your little one, parents who need or choose to nourish their babies in this way should be applauded for their labor of love.