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Feeding Your Infant: Ages 0 to 4 Months

Congratulations! You’re the proud (and nervous) parent of the world’s most beautiful baby! Giving your baby love and nurturing comes so naturally to you. So does showing him or her off to your family, friends, and even perfect strangers! But when it comes to feeding, you may feel a little unsure of what to do. Here are some guidelines.

What Foods Are Best? TOP

Breast milk is the only food recommended for the first 6 months of life. If you cannot breastfeed or express milk, your infant should be fed iron-fortified formula.

How Much Breast Milk or Formula Should I Give? TOP

A newborn baby that is breastfed may feed every 2 hours, even overnight. A bottle-fed baby should drink every 2-3 hours at first. As your baby grows, feed whenever the baby shows signs of hunger.

In the first few weeks, infants should be awakened to feed if 4 hours have passed since the beginning of the last feeding. Your baby will eventually develop a more regular feeding schedule, which may occur about 8 times a day. Your infant may need more breastmilk or formula during certain times like a growth spurt. Follow your baby's hunger signals to know when to feed.

Newborns that are formula fed may drink 2-3 ounces every 3-4 hours. The amount per feeding may vary and will increase as your baby grows. For example, by 2 months, your baby may drink 4-5 ounces every 3-4 hours.

Important Tips

Be Prepared for Growth

Growth spurts will make your baby hungrier. Increase breastmilk or formula as indicated by your baby's needs. Growth spurts may occur at any time.

Foods to Avoid

Do not give cow's milk, honey, syrup, sugared juices or sodas to your baby. Breast milk or iron-fortified formula is all they need.

What Are My Choices? TOP

Benefits of Breastfeeding	Benefits of Iron-Fortified Formula
It is easy to digest. It contains disease-fighting compounds. It is less likely to cause allergies. It helps mother and baby develop a special closeness. It helps baby’s muscles jaw develop. It is always ready to go and cheaper than buying formula. It has been found to help reduce infant obesity, respiratory infections, such as pneumonia, and diarrhea.	It provides adequate nutrition and is a suitable substitute when breast milk is not available. It helps to prevent anemia (low iron in the blood).

Why not cow’s milk?	Why not low-iron formula?
It has too much protein and is harder to digest. It has too many minerals and can be hard on baby’s kidneys. It is low in vitamin C, vitamin E, iron, and copper, which are important for your baby’s growth.	It does not contain enough iron to prevent anemia. It is not a treatment for constipation.

What Can I Expect? TOP

Breastfeeding	Iron-fortified formula
Breastfeeding is a supply and demand way to feed. The more often the baby nurses, the more milk your breasts will produce. A newborn breast-fed baby will nurse an average of 8-12 times in 24 hours. Your baby may need a vitamin D supplement starting in the first few days after birth. Premature babies may need an iron supplement. A breast-fed baby will nurse an average of 20-30 minutes. The length of time will decrease as the baby gets older. During growth spurts, your baby may need to breastfeed more often. This does not mean your milk supply has decreased. A breast-fed baby should have 6-8 wet diapers in 24 hours. A breast-fed baby may have a bowel movement once per day or once with each feeding. Each baby will have their own schedule. Your baby may go several days to a week without having a bowel movement. It is not constipation if the stool is soft. Breast milk should not be heated in the microwave, because it destroys nutrients and can cause hot spots that may burn your baby.	Everything must be kept clean. Wash the top of the formula container before opening. Wash bottles and nipples in hot, sudsy water. Rinse well with hot water. Mix formula carefully, following the directions on the label. Use up one can of formula before opening another. An opened can of ready-made liquid formula is safe for up to 48 hours when tightly covered and refrigerated. Formula prepared for feeding should be refrigerated and used within 24 hours. Formula should not be heated in the microwave because it can cause hot spots that may burn your baby. Formula should not be frozen. If not able to keep formula cold, use powdered formula and mix when needed. Your baby should have 6-8 wet diapers in 24 hours. Formula-fed babies will develop their own pattern of soiled diapers. Watch for your baby’s pattern. Your baby may go several days to a week without having a bowel movement. This is not constipation if the stool is soft. During growth spurts, your baby may need to eat more often.

Breastfeeding

Iron-fortified formula

Breastfeeding is a supply and demand way to feed. The more often the baby nurses, the more milk your breasts will produce.
A newborn breast-fed baby will nurse an average of 8-12 times in 24 hours.
Your baby may need a vitamin D supplement starting in the first few days after birth. Premature babies may need an iron supplement.
A breast-fed baby will nurse an average of 20-30 minutes. The length of time will decrease as the baby gets older.
During growth spurts, your baby may need to breastfeed more often. This does not mean your milk supply has decreased.
A breast-fed baby should have 6-8 wet diapers in 24 hours.
A breast-fed baby may have a bowel movement once per day or once with each feeding. Each baby will have their own schedule. Your baby may go several days to a week without having a bowel movement. It is not constipation if the stool is soft.
Breast milk should not be heated in the microwave, because it destroys nutrients and can cause hot spots that may burn your baby.

Everything must be kept clean. Wash the top of the formula container before opening. Wash bottles and nipples in hot, sudsy water. Rinse well with hot water.
Mix formula carefully, following the directions on the label.
Use up one can of formula before opening another. An opened can of ready-made liquid formula is safe for up to 48 hours when tightly covered and refrigerated.
Formula prepared for feeding should be refrigerated and used within 24 hours.
Formula should not be heated in the microwave because it can cause hot spots that may burn your baby.
Formula should not be frozen.
If not able to keep formula cold, use powdered formula and mix when needed.
Your baby should have 6-8 wet diapers in 24 hours.
Formula-fed babies will develop their own pattern of soiled diapers. Watch for your baby’s pattern. Your baby may go several days to a week without having a bowel movement. This is not constipation if the stool is soft.
During growth spurts, your baby may need to eat more often.

Tips on Bottles and Storage

Bisphenol A (BPA) is a chemical found in a many products, including plastic containers or bottles (with recycling number 7), as well as canned goods. While BPA's effects in humans is still being studied, some experts recommend that you limit your baby's exposure to this chemical.

RESOURCES:

Department of Agriculture
http://www.usda.gov

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

CANADIAN RESOURCES:

About Kids Health—The Hospital for Sick Children
http://www.aboutkidshealth.ca

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org

REFERENCES:

Bottle feeding basics. American Academy of Pediatrics Healthy Children website. Available at: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Bottle-Feeding-How-Its-Done.aspx. Updated November 21, 2015. Accessed June 8, 2016.

Breastfeeding. EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated May 13, 2016. Accessed June 8, 2016.

Breastfeeding vs. formula feeding. Nemours Kids Health website. Available at:
...(Click grey area to select URL)
Updated February 2015. Accessed June 8, 2016.

Feeding your 1-to-3 month old. Nemours Kids Health website. Available at:
...(Click grey area to select URL)
Updated September 2014. Accessed June 8, 2016.

How often and how much should your baby eat? American Academy of Pediatrics Healthy Children website. Available at: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/How-Often-and-How-Much-Should-Your-Baby-Eat.aspx. Updated November 21, 2015. Accessed June 8, 2016.

How to protect your baby from BPA (bisphenol A). Bureau of Environmental Health Massachusetts Department of Public Health website. Accessed June 8, 2016.

Nutrition (pediatric preventive care). EBSCO DynaMed website. Available at:
...(Click grey area to select URL)
Updated May 19, 2016. Accessed June 8, 2016.

Why formula instead of cow's milk? American Academy of Pediatrics Healthy Children website. Available at: https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Why-Formula-Instead-of-Cows-Milk.aspx. Updated November 21, 2015. Accessed June 8, 2016.

10/12/2010 DynaMed's Systematic Literature Surveillance
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Baker R, Greer F, the Committee on Nutrition. Clinical report—diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010;26(5):1040-1050.

4/7/2014 DynaMed's Systematic Literature Surveillance
...(Click grey area to select URL)
Lamberti LM, Zakarija-Grkovic, Fischer Walker CL, et al. Breastfeeding for reducing the risk of pneumonia morbidity and mortality in children under two: a systematic literature review and meta-analysis. BMC Public Health. 2013;13 Suppl 3:S18.

Last reviewed June 2016 by Michael Woods, MD
Last Updated: 6/8/2016

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