How you feed your newborn is the first nutrition decision you will make for your child. Take a closer look at these guidelines for breastfeeding and bottle-feeding so you can make an informed decision.

Breast or Bottle?

The American Academy of Pediatrics (AAP) and other professional groups concerned with the care of newborns advocate breastfeeding as best for your baby. Specifically, the AAP recommends that babies be breastfed exclusively for about the first 6 months. Following the introduction of solid foods, breastfeeding should continue through the first year of life and beyond, if desired.

Breastfeeding may not be possible or preferable for all women. Deciding to breastfeed or bottle-feed a baby is usually based on the mother's comfort level with breastfeeding as well as her lifestyle, but breastfeeding may not be recommended for some mothers and babies. If you have any questions about whether to breastfeed your child, talk to your pediatrician.

Remember, your baby's nutritional and emotional needs will be met whether you choose to breastfeed or formula-feed.

Breastfeeding Advantages

Breastfeeding your newborn has many advantages. Perhaps most important, breast milk is the perfect food for a human baby's digestive system. It contains the vitamins and minerals that a newborn requires, and all of its components — lactose, protein (whey and casein), and fat — are easily digested by a newborn's immature system. Commercial formulas try to imitate breast milk, and come close, but the exact composition cannot be duplicated.

Also, breast milk contains antibodies that help protect infants from a wide variety of infectious diseases, including diarrhea. Studies suggest that breastfed babies are less likely to develop certain medical problems, including diabetes, high cholesterol, asthma, and allergies. Breastfeeding may also decrease the chances that the child will become overweight or obese.

Breastfeeding is great for moms, too. It burns calories and helps shrink the uterus, so nursing moms get back into shape quicker. Breastfeeding may also protect mom from breast and ovarian cancer.

Some moms find breastfeeding easier and quicker than formula-feeding; it needs no preparation, and you don't run out of breast milk in the middle of the night. Also, breastfeeding costs little. Nursing mothers do need to eat more and may want to buy nursing bras and pads, a breast pump, or other equipment. But these expenses are generally less than the cost of formula.

Breastfeeding meets a variety of emotional needs for both moms and babies — the skin-to-skin contact can enhance the emotional connection, and providing complete nourishment can help a new mother feel confident in her ability to care for her newborn.

Formula-feeding Advantages

Commercially prepared infant formula is a nutritious alternative to breast milk. Bottle-feeding can offer more freedom and flexibility for the mother, and it makes it easier to know how much the baby is getting.

Because babies digest formula more slowly than breast milk, a baby who is getting formula may need fewer feedings than one who breastfeeds. Formula-feeding also can make it easier to feed the baby in public, and allows the father and other family members to help feed the baby, which can enhance bonding.

Considering the Limitations

Breastfeeding

With all the good things known about breastfeeding, why doesn't every mother choose to breastfeed?

Breastfeeding requires a substantial commitment from a mother. Some mothers feel tied down by the constant demands of a nursing newborn. Since breast milk is easily digested, breastfed babies tend to eat more often than babies who are fed formula. This means mom may find herself in demand as frequently as every 2 or 3 hours in the first few weeks. This can be tiring, but it's not long before babies feed less frequently and sleep longer at night.

Some new mothers need to get back to work outside the home or separate from their babies from time to time for other reasons. Some of these moms opt for formula-feeding so other caregivers can give the baby a bottle. Mothers who want to continue breastfeeding can use a breast pump to collect breast milk to be given in a bottle so their babies still get its benefits even when mom isn't available to breastfeed.

Other family members (dads most of all) may want to share in this most fundamental of baby care routines and participate in feeding the baby. When mom is breastfeeding, dad or siblings may want to stay close by. Helping mom get comfortable, or providing a burp cloth when needed, will let them be part of the experience. Once breastfeeding is established, other family members can help out by giving the baby pumped breast milk in a bottle when mom needs a break.

Sometimes a woman may feel embarrassed or apprehensive about the prospect of breastfeeding. These feelings usually disappear once a successful breastfeeding process is set. It's often helpful to seek advice and perspective from those who've gone through the experience. Most hospitals and birthing centers can provide in-depth instruction on breastfeeding techniques to new mothers. Your pediatrician, nurse practitioner, or nurse can answer questions or put you in touch with a lactation consultant or a breastfeeding support group.

In some cases, a mother's health may interfere with her ability to breastfeed. For example, mothers undergoing chemotherapy for cancer and moms who are infected with human immunodeficiency virus (HIV, the virus that causes AIDS) should not breastfeed. If you have a medical condition or take any medications regularly, or if you or your baby get sick, talk with your doctor about whether it's OK to breastfeed. If you have to stop nursing temporarily, it's important to continue to pump breast milk to maintain milk production.

In some situations, it may not possible to breastfeed, such as when a baby is sick or born prematurely. Mothers should speak with their baby's doctor about expressing and storing milk. Even if the infant cannot breastfeed, breast milk may be given via a feeding tube or bottle.

Sometimes mothers who have inverted nipples may have difficulty breastfeeding, but with the help of a lactation consultant this usually can be overcome. Likewise, women who have had plastic surgery on their breasts should be able to successfully breastfeed. Be sure to speak to your doctor if you have any concerns.

Avoid using pacifiers or bottles until after the first month of life. Introducing them before breastfeeding is known to cause "nipple confusion," and can lead to an infant giving up the breast.

Formula-feeding

Just as breastfeeding has its unique demands, so does bottle-feeding. Bottle-feeding can require a great deal of organization and preparation, especially if you want to take your baby out. Also, formula costs can be considerable.

It's important to make sure that you have enough formula on hand, and bottles that are clean and ready to be used. Here are a few key guidelines for formula feeding:

• Be sure to carefully follow directions on the label when preparing formula.
• Bottles left out of the refrigerator longer than 1 hour and any formula left in the bottle that a baby doesn't finish should be discarded.
• Prepared bottles of formula should be stored in the refrigerator for no longer than 24 hours and should be carefully warmed just before feeding.
• A bottle of formula (or breast milk) should not be warmed in a microwave. The bottle can heat unevenly and leave "hot spots" that can burn a baby's mouth.

Is My Newborn Getting Enough to Eat?

Your newborn should be nursing eight to 12 times per day during about the first month. In the beginning, mothers may want to try nursing 10 to 15 minutes on each breast, then vary the time as necessary.

Once your milk supply is established, breastfeeding should be "on demand" (when your baby is hungry), which is generally every 1 to 3 hours. As newborns get older, they'll need to nurse less frequently — some may feed every hour and a half, whereas others may go 2 or 3 hours between feedings. For babies who are getting formula, they'll likely take about 2 to 3 ounces every 2 to 4 hours. Newborns should not go more than about 4 hours without feeding.

Call your baby's doctor if you need to awaken your newborn frequently or continually urge your baby to suck.

Most experts suggest you nurse or feed your baby whenever he or she seems hungry. Signs that babies are hungry include:

• moving their heads from side to side
• opening their mouths
• sticking out their tongues
• placing their hands and fists to their mouths
• puckering their lips as if to suck
• nuzzling again their mothers' breasts
• showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

A rigid feeding schedule is not necessary; you and your baby will eventually establish your unique feeding pattern. Babies know (and will let their parents know) when they're hungry and when they've had enough. Watch for signs that your baby is full (slow, uninterested sucking; turning away from the breast or bottle) and stop the feeding once these signs appear.

As babies gain weight, they begin to eat more at each feeding and go longer between feedings. There may be other times when your infant seems hungrier than usual. Continue to nurse or feed on demand. Nursing mothers need not worry — breastfeeding stimulates milk production and your supply of breast milk will automatically adjust to your baby's demand for it.

New mothers, especially breastfeeding moms, are often concerned that their infants may not be getting enough to eat. It's important for breastfed infants to be seen by their pediatrician 48 to 72 hours after a mother and newborn leave the hospital. During this visit, the baby will be weighed and examined, and the mother's breastfeeding technique can be evaluated. It's also an opportunity for nursing mothers to ask questions. If a breastfed baby is doing well, the doctor will probably schedule another visit for around 2 weeks of age. Formula-fed babies are usually checked between 2 and 4 weeks of age, unless parents have specific concerns.

You can be assured that your baby is getting enough to eat if he or she seems satisfied, produces about four to six wet diapers a day, has regular bowel movements, sleeps well, is alert when awake, and is gaining weight. A baby who is fussing, crying, seems hungry, and does not appear satisfied after feeding may not be getting enough to eat. If you're concerned that your baby isn't getting enough to eat, call your doctor.

Many infants "spit up" a small amount after eating or during burping, but a baby should not vomit after feeding. This can be due to overfeeding, but vomiting after every feeding may be a sign of an allergy, digestive problem, or other problem that needs medical attention. If you have concerns that your baby is spitting up too much, call your doctor.

Although your baby will probably start on some solid foods between 4 and 6 months, breast milk or formula will remain the most important source of nutrition through the first year of life.

Nutritional Supplements

Breast milk contains the right combination of vitamins and easily absorbed iron that will be sufficient until your baby begins eating iron-rich cereals around 6 months of age. A healthy infant being nursed by a healthy mother does not need any additional vitamins or nutritional supplements, with the exception of vitamin D. Breast milk does contain some vitamin D, and vitamin D is produced by the body when the skin is exposed to sunlight. However, sun exposure increases the risk of skin damage, so parents are advised to minimize exposure. The AAP recommends that all breastfed babies begin receiving vitamin D supplements during the first 2 months and continuing until the infant consumes enough vitamin D-fortified formula or milk (after 1 year of age).

Formula contains the right blend of vitamins, including vitamin D, for a baby, so supplements are usually not necessary. Iron-fortified formula is recommended for a baby's first year and should contain up to 12 milligrams of iron per liter.

Water, juice, and other foods are usually unnecessary during a baby's first 6 months. Breast milk or formula provides everything babies need nutritionally until they start eating solid foods. Talk to your doctor if you have any questions about feeding your newborn.

Reviewed by: Steven Dowshen, MD
Date reviewed: August 2008