Infant Feeding Recommendations
The choice parents make about how to feed their child is an important and personal decision rooted in individual beliefs, circumstances and experiences. Whether a parent decides to breastfeed exclusively, formula feed, or use a combination of both, they should be supported in their decision.
For information regarding infant recommendations encompassed in the 2020-2025 Dietary Guidelines for Americans, click here.
The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for about the first six months, followed by a year or longer (as mutually desired by mother and child) of continued breastfeeding as complementary foods are introduced. Additionally, AAP and INCA recommend exclusively breastfed infants receive vitamin D supplements. For more information about breastfeeding click here.
According to the 2020 Breastfeeding Report Card by the Centers for Disease Control (CDC), 84.1% of babies in the U.S. start out breastfeeding and nearly 60% are still breastfeeding at six months of age. According to the CDC this “high percentage of babies who start out breastfeeding shows that most mothers want to breastfeed and are trying to do so.”
A recent Infant Nutrition Council of America survey of parents and caregivers showed that the vast majority of moms initiate breastfeeding because of the health benefits. That said, 9 out of 10 moms assert that it is their decision on how to feed their baby and want to feel supported in their decision.
While breastfeeding rates continue to increase, a significant number of mothers and caregivers use some combination of breast milk and infant formula.
It is important that new and expecting parents are provided with evidence-based information regarding safe and nutritious infant feeding options, regardless of whether they breastfeed, formula-feed or use a combination of both options. Parents and caregivers are encouraged to contact their healthcare provider or pediatrician before their baby is born to determine which infant feeding options will work best for their particular circumstances.
Infant formula is available in three types: ready-to-feed liquid, concentrated liquid and powder. All commercial infant formulas must contain the ingredients needed to support infant nutrition.
- Ready-to-feed liquid formulas are used as-is. Ready-to-feed is the most expensive, but is very convenient as it requires no mixing or measuring. This type of formula may be recommended when safe water is not readily accessible.
- Concentrated liquid formulas require mixing with water according to the instructions on the container.
- Powdered formulas must be reconstituted with water according to the instructions on the container. Powdered formula is not a sterile product and thus can be more susceptible to contamination if improperly handled, so parents and caregivers should closely follow the preparation instructions when preparing bottles.
It is important to purchase infant formula from reputable retailers, either in their physical stores or through their official website, to ensure safety. INCA does not recommend purchasing infant formula from individuals, such as at flea markets, on e-commerce websites or on internet auction sites. These products may have been improperly stored or shipped, which can negatively affect the quality of the formula.
Identifying and managing potential allergies
If there are signs of discomfort during or shortly after eating, a child may have a dairy intolerance or allergy. Dairy intolerance can occur when a baby has problems digesting milk, with the problem often being due to lactose.
Infant formula manufacturers use advancements in the scientific understanding of infant nutrition to offer a variety of formulas, including specialty formulas for infants whose needs may not be met by breast milk or who do not tolerate traditional formula. This enables parents and healthcare professionals to choose the most appropriate product for each infant based on the different dietary needs and restrictions they may have.
If an intolerance or allergy is confirmed by a healthcare provider, one of the following options may be suggested:
- Lactose-free formula: Babies with lactose intolerance can thrive on lactose-free formulas, which are found in ready-to-drink and powdered options.
- Soy Formula: Several varieties of non-dairy soy formula are usually available at neighborhood grocery stores. Products may include different forms such as ready-to-drink and powdered formula, as well as organic and vegan options, for those parents looking for those options for their family.
- Breastfeeding: Moms who are breastfeeding a baby with a dairy intolerance or allergy may want to speak with a dietitian or physician, as sometimes the dairy products mom eats can have a negative impact on their baby’s sensitive tummy. It’s also worth noting that if mom or dad has dairy intolerance or allergy, this doesn’t mean the baby will.
- Elemental Formula: Often prescribed by a doctor, elemental formula is “hypoallergenic”, which means it is extra gentle for a baby’s tummy. Parents should talk to their pediatrician to see if an elemental or another hypoallergenic formula may be the right option for their baby.
It is common for parents to use combination feeding, feeding a child with both breast milk and infant formula. According to the Centers for Disease Control and Prevention (CDC), one-third of moms in the U.S. supplement breast milk with infant formula by the time a child is six months in age. Likewise, a recent INCA survey of parents and caregivers showed that 70 percent of babies receive both breast milk and infant formula in the first 12 months of life.
Parents and caregivers should speak with a healthcare provider to establish the eating habits that will best provide their child with the nutrients they need.
When bottle-feeding, whether with breast milk or infant formula, it is important for parents and caregivers to recognize a child’s hunger cues and not override them by continuing to feed when the child is signaling he or she is done feeding.
One way parents can avoid overfeeding is to pay attention to how much their child generally eats during each feeding, and prepare bottles or freeze breast milk bags with just that amount. This amount will adjust as your infant grows. Preparing bottles in portions can reduce the risk of overfeeding or having to throw away an unfinished bottle. Parents should not use leftovers for the next feeding, as it can be unsafe.
Questions to ask when determining if an infant has had the right amount to eat:
- Are they frequently spitting up?
A baby could be overeating if they spit up 20-25 minutes after eating for, but rarely spit-up after eating for 10-15 minutes. If it’s the latter, parents should try limiting mealtimes and see if their child continues to spit up. If frequent spitting up continues they should talk to their pediatrician.
- How long has it been between feedings?
Most babies eat every two to three hours. When parents wait the full three hours between feedings, their baby will be hungry when they start to eat, making it easier for both parent and baby to tell when they are full. Older babies will often start to look around and pull away from the breast or bottle when they are no longer hungry, so parents should look for that as an additional cue.
- What does the scale say?
If a child is progressing on schedule, that’s an indication they’re getting enough to eat at meal times. If a parent is ever worried their child isn’t getting enough nutrition, they should consider taking them to their pediatrician’s office for more frequent check-ins.
Parents should not use food to soothe a child. While a hungry baby needs food, a crying, upset baby may get more frustrated if food is offered when they’re not hungry. Signs of hunger include restlessness, sucking on firsts or smacking lips.
The American Academy of Pediatrics Committee on Nutrition (AAP) recommends exclusive breastfeeding for about six months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for one year or longer as mutually desired by mother and infant. Similarly, for parents and caregivers feeding infant formula, experts recommend continuing to feed infant formula until an infant is at least 12 months old.
Because nutrients in solid baby foods, commercially prepared or homemade, can vary considerably, the transition from breast milk and/or infant formula to solid foods should be gradual. Parents and caregivers should continue to give their child breast milk and/or infant formula as they introduce solid foods and milk. For children older than 12 months, some parents may consider incorporating toddler nutritional drinks to help balance their child’s diet.
While babies younger than six months typically do not need to consume complementary solid foods, they may become curious about other foods between the ages of four and six months.
As a baby develops this interest, parents should check for other signs that their baby is ready for solid food including being able to hold their head up, opening their mouth when they see food and being able to move food in their mouths to swallow it. Once a child shows signs that they are ready to eat solid food, parents should discuss the best ways to introduce spoon-feeding with their pediatrician.
The AAP recommends that parents and caregivers wait to feed their child solid foods until they weigh at least 13 pounds.