Breast + Formula Feeding FAQ
Breast + Formula Feeding: FAQ
Written by Jade | Midwife, Mama of 3 & Tiny Hearts Educator
When you have a bub, you've got two options when it comes to feeding; Breastmilk or formula. Lots of parents have many questions about feeding, both bottle + breast, so we've made this blog to answer some of those questions for you!
feeding in general
"How do i know my bub is getting enough milk?"
Signs your bub is getting enough milk:
- They have at least 6-8 wet cloth nappies or 5-7 disposable nappies in 24 hours that are light in colour and don't smell.
- They have runny poos that are a yellow-mustard colour [hint: some breastfed babies won't poo every day; some will poo at every feed. Learn what is normal for your bub]. Also good to know is that if bub is on solids, the consistency and colour of their poo may change.
- Bub is alert, has a wet mouth and is their normal colour.
- Your little one is gaining weight normally, which can be checked by tracking their growth along their growth percentile chart over time.
- Bub is mostly settled and content after feeding [remember: it's normal for bub to be unsettled sometimes, so don't let this fool you].
"How much milk does bub need in the early days?"
Your newborn bub's tummy is the size of a marble on their first day of being earthside, which equals around 5-7ml. This proves to us that the small amount of colostrum or formula that bub gets is all they need in the first few days of life. On day three, their tummy is about the size of a ping pong ball, which is around 22-27ml. Around day 3-5 is when a mama's milk will start to come in, coinciding with an increase in bub's tummy capacity. By day ten, your little one's tummy will be similar to a chicken egg, which equals around 60-81ml. At each stage, some bub's will want more or less milk than others. Either way, bub's tummy is only little, which means it's NORMAL for them to feed very regularly.
"what is feeding on demand?"
Feeding on demand means a parent is watching for and following bub's natural feeding cues to know when bub is ready for a feed. Demand feeding can cause anxiety in some parents, particularly if breastfeeding because it may seem like bub is constantly hungry or wanting to feed too much, which can leave you questioning your supply. But keep an eye on the other signs bub is getting enough milk, and have faith that your bub knows what they need, regardless of if they're breast or bottle-fed. And remember, staring at the clock doesn't help anyone.
"how do i know when bub is ready for a feed?"
As a part of their natural newborn instincts, bubs will display certain behaviours that give their parents a clue that they're getting hungry. Feeding cues are easily missed as they may be subtle in the early days, so knowing what to look out for is vital to make sure you're getting to bub early, before they get worked up.
Some of those early cues include:
- Stirring and starting to wake up more
- Opening their mouth
- Turning their head and moving towards things that brush past them [rooting reflex]
If those early feeding cues are missed, bub's behaviour may escalate into:
- Increasing their physical movements, like moving arms and legs
- Sucking on their hands or trying to suck anything that brushes past their mouth
Again, if both of those early and mid-feeding cues are missed, bub may be starting to get cranky and may begin:
- Thrashing their body around
- Turning red from crying
Once bub is cranky and upset, try calming them, then feeding them. The secret to it is to watch your bub; not the clock.
"What does it mean if my bub needs extra feeds?"
If bub isn't feeding well or needs extra milk for a medical reason, they may be recommended to begin top-ups using bottles, a nasogastric tube or a supply line.
A supply line is when expressed breast milk or formula is given to bub through a small tube that is taped to the breast. One end of the tube is inside a container of bub's milk, while the other end of the tube is close to the nipple, meaning when bub sucks at the breast, they will receive extra milk through the tube. This may be beneficial for bubs who tire at the breast easily, such as preterm bubs, when mamas want to avoid giving their bubs a bottle, but top-ups are medically indicated, when a mama is experiencing low milk supply that's because sucking at the breast encourages increased milk production, or when someone didn't give birth to bub but wants to establish breastfeeding [such as adoption or surrogacy].
I've heard bigger kids in hospital call them a "nose hose" [how cute!], but these thin, soft tubes that enter the nostril and pass down the throat in the tummy are seen in very little bubs too - sometimes having to be inserted soon after a bub enters the world. This is so bub can get more milk without having to work for it [such as for bubs who are very unwell, had surgery, are lethargic or preterm]
Top ups are extra expressed breastmilk, formula or donated breastmilk that is given in addition to bub's breastfeed to meet a quota. If bub is exclusively formula fed, it will just be the total amount of milk they are recommended to have.
"do i need to burp a breastfed or formula fed baby?"
Burping is done to bring up any air bubbles or trapped wind in a bub's belly after feeding. Trapped wind can cause belly pain which is why burping them can help them to settle.
It depends. Some sources say that if a breastfed bub's latch is good, they won't need to be burped because they're swallowing minimal air. Others say that regardless, they shouldn't need to be burped at all. In saying that, some babies do bring up wind after breastfeeding, so burping them does help them to settle. This is also more likely if a mama has a strong or quick let down and bub is gulping down the milk or if bub is crying between switching sides.
Most sources agree that bottle-fed bubs should be burped at least halfway through a feed and at the end of a feed. Other times that a burp may be beneficial is if bub is drinking very slowly, or approx after every 500ml. To try and minimise the air bub swallows, make sure the teat is completely full, bub is in a semi-upright position, and the speed flow of the teat is appropriate to bub's age and development.
If bub hasn't burped, but they seem content and comfortable, there's no need to keep going until they bring up a burp. You're the expert on your little one, so listen to what those parental instincts are telling you.
"what about reflux in bubs?"
Reflux in babies happens when milk from bub's tummy is brought back up into the mouth or oesophagus [tube that connects the mouth and stomach].
If your bub has mild reflux, they will posset [spit up] milk and be normal in every other way, like gaining weight appropriately. It's important to note that some of these bubs get colic, which can be just as stressful.
Reflux disease is a medical condition that requires medical advice. Your bub may vomit large amounts of milk, cry in pain after feeds, always fuss, have a swollen tummy, have problems gaining weight or breathing problems.
Here are some other tips and tricks to manage a bub with reflux or colic:
- Willby's Wind and Colic mix
- Keep bub upright for about 30min after feeding
- Feed bub in a more upright position
- Feed thickeners [always check with your doctor first]
- Consider smaller, more frequent feeds
- Baby-wear. Absolute life-saver
- Have a break when you can
- Sometimes you need a good cry to let it all out, and that's ok too. You're doing the best you can.
"what do i need to know about introducing water?"
If your little one is under six months old, they only need to drink breastmilk or infant formula. From 6 months of age, you can give your baby small amounts of water, if required, in addition to their breastmilk or formula feeds.If your little love is around six months of age, you can offer small amounts of cooled boiled tap water - but it shouldn't replace their breastmilk or formula feeds. Breastmilk and formula should still be their main drink up to 12 months of age. If your bub has just started solids, start with a few sips of water from a cup when they're eating.
That's because when under 6 months, breastmilk or formula is both food and drink for your little one. It's all they need - even in hot weather. Giving your bub water may mean they drink less breastmilk or formula and puts them at risk of not growing properly. Even more alarmingly, giving your bub a lot of water or excessively diluted formula over a short time can make them very unwell.
After 12 months, their main drink should be water and cow's milk or breastmilk. There's also no need to boil tap water once your little one has reached 12 months.
"What do I do with feeling if bub has a fever?"
If your little one has a fever, is under six months and is breastfed, you may need to offer extra breastfeeds. If they are under six months and formula-fed, you can offer smaller amounts of formula more frequently. The Royal Children's Hospital also has some guidelines about oral rehydration solutions, which can be found online. Don't offer water unless advised by a doctor. If your bub is 6m+, continue to breastfeed or bottle feed. You can offer small amounts of water in between feeds, but the most important thing to monitor is whether your little one is getting enough fluids.
"How do i increase my milk supply?"
When your little one is sucking at the breast, nerves within the nipple are stimulated, causing two hormones to be released; Oxytocin and Prolactin. Prolactin activates the tissue within the breast that helps to make milk, while Oxytocin causes an ejection of milk out of the breast [the let-down reflex].
To put it simply, demand = supply.
What this means is if your bub is breastfeeding more frequently, such as what happens with cluster feeding, your breasts are likely going to be emptier than usual [keeping in mind they are never completely empty]. This tells your body to make more milk in order to fill the breasts quicker. Other things you can try:
- Check bub's attachment at every feed to maximise the milk transfer during the feed
- Try offering the breast instead of comforters such as a dummy to allow for more stimulation at the breast
- Switching bub at the breast when their sucking seems to taper off to try and stimulate another let-down reflex
- Offer snack feeds to try and increase the amount of feeds bub is having
- Try massaging the breast during feeds
- Warm the breast before feeds to help open the milk ducts
- Some mamas swear by lactation cookies
- Chat with a Lactation Consultant for more ideas
"Help! My bub is biting at the breast!"
If bub is teething and has sore gums, they might attempt to bite the breast while breastfeeding. Instead of biting, other bubs may rest their teeth on the breast or nipple, which can leave little marks and may cause discomfort. The ABA also says that some parents feel that their nipples can become more irritated while bub is teething due to changes in bub's saliva.
These scenarios can cause pain, discomfort and a reluctance to breastfeed. To try and prevent this from occurring, you could try:
- Giving bub something to chew on before feeding
- Rubbing bub's gums before a feed
- Taking bub off the breast as soon as they bite
- Try and avoid giving a big reaction
- Give bub a toy to play with while feeding as a distraction
- Make sure bub is properly attached for the whole feed. If bub is attached properly and sucking, they're unable to bite because their tongue will cover their bottom teeth and gums
- Take extra care before and after a feed as this is the most common time babies will bite the breast
- Treating any bites the same as you would a cracked nipple
- Monitor any bites during the healing process
- Chat to a lactation consultant for further advice
- Demand feed your bub by responding to hunger cues
- Watch for cues of bub needing a break - stopping sucking, turning their head or pushing away the bottle
- Hold your bub semi-upright to feed, and look into their eyes to make them feel safe and loved
- You can do skin to skin while bottle-feeding
- Sterilse all bottle parts, follow package instructions, use cooled boiled water (test on your wrist first)
- Bub will stop feeding when full, don't force them to finish the bottle
Due to the stringent requirements here in Australia, all cow's milk-based formulas meet strict standards and are of similar quality and nutritional value. So don't get too caught up in this. It's also good to know that 'follow-on' formula is a bit of a gimmick; you can pick one formula and use it until bub is 1, when food, water and Cow's milk will take over.
"how do i deal with the bottle-feeding guilt?"
Did I know all the incredible benefits of breastmilk? Yes. Did I still choose to formula feed my babies? Also yes.
People choose which way to feed their baby based on a multitude of reasons; many are deeply personal. A happy mum, and full baby are what matters.
Your breastfeeding journey might have been painful; your milk didn't come in, your baby has whisked away to NICU, had low sugar levels or poor weight gain. Maybe you were unwell after delivering and couldn't be with bub; perhaps you didn't have the support you needed, bub wouldn't latch, or you had mastitis too many times. Maybe you had to return to work or weren't in the right place mentally. Maybe you've had breast cancer or experienced sexual abuse. Or maybe you just didn't want too. It doesn't matter why, but it's ok, and you don't need to explain.
It doesn't matter if you choose to breastfeed, mix feed or bottlefeed. It doesn't matter if you use your breastmilk, donor breastmilk or formula. What matters is that you are INFORMED, your baby is FED.
"any other important info?"
- It's not unusual for a bub to feed 8-15 times during 24 hours
- If your bub is breastfeeding at the breast, you can't overfeed them
- Bub will wake to feed overnight. This is normal because bub's tummy is so small, so it's normal that it will empty quicker, meaning it will need to be refilled more often too
- It is NORMAL for all babies to go through periods of cluster feeding [wanting to feed constantly].
- Cluster feeding is common on day two as bub tries to bring in your milk, again at two-three weeks and six weeks, and in the evenings.
- It is NORMAL for bub to lose weight [up to 7-10% of birth weight] after birth. Bub should be back at birth weight by 14 days of age.
- Bub should have one wet nappy on day one, two wet nappies on day two, three on day three and four on day four. From day five, we want to see 6-8 each day.
- Around day two, bub might have urates in their nappy which look like an orange-red stain. Some parents describe this as looking like rust. This is NORMAL but if you see urates after day four, check with your bub's medical team.
I hope this helps you better understand feeding bubs better. In the comments on the original post, tag your fam + friends, and while you're there I'd love to read about your experiences with on your feeding journey, so feel free to share if you feel comfortable doing so. ✨
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