With 96 per cent of mamas starting out offering the breast, most new families in Australia are keen on breastfeeding. But less than 40 per cent of bubs are still exclusively breastfed by the age of four months, and by six months, while about 60 per cent of babies receive some breastmilk, most have been introduced to formula.

The top reasons mums say they turn to bottle-feeding are not having enough breastmilk, problems with attachment, unsettled babies and pain during breastfeeding. Other reasons formula may come into the equation are working arrangements and expressing becoming too difficult.

It’s a very personal decision to choose to formula-feed your bub, but all mums do the very best they can. If you are going to be offering formula, it’s important to know how to go about it. Here’s what you need to know.

1. Don't be bamboozled

With so many formulas promoting so many different benefits (from boosting intelligence and eyesight to having all sorts of extra vitamins and minerals), it can be confusing to work out which is best for your baby. The good news is that you’re not compromising your bub by choosing one brand over another. “There is little evidence at this time that special additives found in some formulas make any significant difference to babies’ development over basic formulas,” says Joy Anderson, a lactation consultant and accredited practising dietitian with a special interest in infant feeding. All formulas suitable from birth are okay to use for children with no proven allergies until 12 months, though “after six months, a ‘follow-on’ version has no particular advantages,” she adds.

2. Mix it up

Breastmilk’s flavour can change according to what foods you’ve been eating, so there’s no reason your formula-fed bub can’t experience a bit of variation, too.

“You might like to try different formulas, as each one tastes slightly different,” says lactation consultant Shona Cassels, a mother of two who bottle-fed her first child and breastfed her second. “Your baby might enjoy the variety.”

3. Get equipped

You’ll need between two and six large bottles made of glass or BPA-free plastic, several teats, which can be made from clear silicone or brownish latex, a knife to level the powder and a bottle brush to clean with. When it comes to teat shape, don’t stress too much. According to the National Health and Medical Research Council, “shape variations have no particular advantages unless the infant prefers that shape”. Be guided by what your little one likes. While some experts don’t believe sterilisation of feeding equipment is necessary (outside of washing everything very thoroughly, of course), you may also want sterilising equipment for the first six months. Bottles can be sterilised for each use by boiling or microwaving, using an electric steam steriliser, or with a special antibacterial solution.

4. Prepare it properly

It’s important to follow the instructions on the tin exactly, as “there’s a lot of science that goes into formula and its ratio to water,” explains Dr Ginni Mansberg, PP’s resident GP. Making up the wrong ratio can mean your baby misses out on important nutrition or winds up constipated. Be aware that directions change between brands and types of formulas. Also, always go with the scoop provided with each new tin, as these can differ in size. “Using the wrong scoop can make the formula too concentrated and it can overload the kidneys,” Dr Mansberg warns.

5. Be even tempered

There are a few vital steps in warming up formula for your littlie. If you can, make up the formula fresh for each feed. According to World Health Organization guidelines, you can boil the water (including bottled water) in a kettle, but make sure it switches off or the water comes to a rolling boil before you use it. While it may not always be practical, the guidelines do say to leave the water to cool to no less than 70˚C – that’s no longer than 30 minutes – after boiling. After mixing in the powdered formula, cool the feed quickly by holding the bottle under tap water or placing it in a container of cold water.

If preparing formula in advance, pop the cooled bottle or lidded jug in the fridge and store for no more than 24 hours. If you’re going out, bring the powdered formula with you and make it up fresh, or keep the pre-prepared milk cold with an ice brick and re-warm in a bowl of warm water or an electric
bottle warmer for no more than 15 minutes just before feed time.

“Always test the temperature of the milk before giving it to your baby to make sure it’s not too hot,” says Shona. “And never use a microwave to heat a bottle, as this can lead to hot spots in the milk and the risk of scalding.”

6. If in doubt, chuck it out

Just as you shouldn’t zap last night’s cold pizza more than once, rewarming bub’s bottle is a no-no, too. “Milk is a nirvana for bacteria. Once you’ve warmed up a bottle for a baby and she doesn’t seem interested, you can’t put it back in the fridge and use it later, as the bacteria won’t be killed off,” says Dr Mansberg. “It can really make your baby quite sick and you don’t want to take that sort of risk.” If money is tight and you don’t want formula to go to waste, Dr Mansberg suggests making up a 120ml bottle instead of a 250ml bottle to see if your baby wants it all.

7. Don't add extras

No matter how many times your aunty or mother-in-law tells you how adding infant cereal to a bottle might help bub sleep through the night, don’t do it! “You don’t want to be adding anything to formula as it can change the constitution of the milk and your baby can become quite sick,” Dr Mansberg says. “Unless you’re directed to by your doctor, just exactly obey the instructions on the tin.” Some mums with refluxy babies may have heard of thickeners you can add to formula, but Dr Mansberg advises against these. “It’s better to use specific reflux formulas than to take the existing formula and thicken it,” she says.

8. Be on poo watch

Babies can become a bit constipated when first moving on to formula, or when switching formula types. A little bit of straining while filling a nappy with a number two is normal, and if your little one’s poo is pasty in consistency this is a good sign she’s not constipated. If your feel your baby is blocked up, Dr Mansberg suggests giving extra water in a bottle over a few days, but “if your baby pulls her legs up, gets red in the face and nothing’s coming out, she’s farting a lot and the poo looks like little pebbles, that’s a problem,” she says. If this is the case, see your doctor or child health nurse.

9. Swap sides

If you’re right-handed, you’ll tend to hold bub in your left arm and the bottle in your right, but there is good reason to vary this routine for each feed. “Alternate the side you hold your baby on to allow both bub’s eyes to get equal exercise,” says Shona. “This mimics the eye stimulation that occurs when breastfeeding.”

10. Take steps to make peace

The decision to formula-feed your baby is often one made during a time of emotional stress, especially if breastfeeding isn’t working out the way you hoped. “This is when you will need to refocus,” says clinical psychologist Dr Maya Griffiths, who suggests challenging unhelpful thinking patterns, such as dwelling on the negative and feeling guilty that you’ve broken a rule about how you ‘should’ be. She suggests asking yourself the following questions as a way to become more rational and happier:
''* What is the effect of thinking the way I do?
* Am I condemning myself as a person based on one event?
* Am I asking questions that have no answer, or am I focusing on my weaknesses and forgetting my strengths?''

“We are our own harshest critics and it’s easy for others to judge us when they aren’t in the situation themselves,” Dr Griffiths adds. “As long as bub is healthy and you have a loving relationship with her, that’s all that matters.”

The National Health and Medical Research Council recommends that babies be exclusively breastfed until around six months of age, with breastfeeding to continue alongside appropriate first foods until at least 12 months of age. While breastfeeding is the ideal way to nourish your baby, we recognise that not all mums are able to do so. If you have any concerns about your breastfed or bottle-fed baby, make an appointment with your child health nurse or GP.

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