II. Management: Formula Amounts (Human Milk needs no supplementation)
- Age 0-1 weeks: 15-20 ounces/day (term infant)
- Calculation: 5 oz/kg/day (150 ml/kg/day) divided over 6-8 feeds/day
- Per-feed: 1-2 ounces every 2-3 hours (increases to 2-4 ounces/feed after first 1-2 weeks)
- Calories: 150 kcal/kg/day
- Age 0-1 months: 18-24 ounces/day
- Age 1-2 months: 22-28 ounces/day
- Age 2-3 months: 25-32 ounces/day
- Age 3-4 months: 28-32 ounces/day
- Age 4-5 months: 27-39 ounces/day
- Age 5-6 months: 27-45 ounces/day
III. Types
- Term Formula
- Commercial products: Enfamil with iron, Similac with Iron, Carnation Good Start
- Cow's Milk formula with lactose Carbohydrate source and 20 kcals/ounce
- Preferred option for most term infants
- Term Formula with long-chain polyunsaturated Fatty Acids
- Commercial products: Enfamil Lipil, Good Start DHA/ARA, Similac Advance
- Cow's Milk formula with lactose Carbohydrate source and 20 kcals/ounce
- DHA and ARA postulated to improve eye and brain development (no benefit in most RCTs)
- Enriched Formula
- Commercial products: Enfacare, Similac Neosure
- Cow's Milk formula with lactose Carbohydrate source and 22 kcals/ounce
- Indicated as transition from Preterm Formula to Term Formula for those 34-36 weeks, >1800 g
- Preterm Formula
- Commercial products: Enfamil 24 premature, Preemie SMA 24, Similac 24 Special Care
- Cow's Milk formula with lactose Carbohydrate source and 24 kcals/ounce
- Indicated for hospitalized Premature Infants <34 weeks gestation and <1800 gram weight
- Soy Formula
- Commercial products: Enfamil Prosobee, Good Start Soy, Similac Isomil
- Soy Formula with corn-based Carbohydrate source and 20 kcals/ounce
- Indicated for Galactosemia, congenital Lactase Deficiency, Vegan families
- Not indicated for colic, milk Protein allergy or Acute Gastroenteritis recovery
- Lactose-Free Formula
- Commercial products: Enfamil Lactofree, Similac Sensitive
- Cow's milk formula with corn-based Carbohydrate source and 20 kcals/ounce
- Indicated for Galactosemia, Lactase Deficiency, Gastroenteritis recovery in low weight infants
- Not indicated for colic (nothing is, although may be tried) or milk Protein allergy
- Hypoallergenic Formula
- Commercial products: Similac Alimentum, Enfamil Nutramigen, Enfamil Progestimil
- Hydrolyzed formula with corn or sucrose-based Carbohydrate source and 20 kcals/ounce
- Indicated for milk Protein allergy (Eczema, Asthma)
- Nonallergenic Formula
- Commercial products: Elecare, Neocate, Nutramigen AA
- Amino Acid formula with corn or sucrose-based Carbohydrate source and 20 kcals/ounce
- Indicated for milk Protein allergy, Atopy (Eczema, Asthma)
- Antireflux Formula
- Commercial products: Enfamil AR, Similac Sensitive RS
- Cow's Milk formula, lactose-based thickened with rice starch and 20 kcals/ounce
- Indicated for Gastroesophageal Reflux
- Typically this is made at home by thickening Term Formula with rice cereal.
- Toddler Formula
- Commercial products: Enfamil Next Step, Good Start 2, Similac Go and Grow
- Cow's Milk formula with lactose Carbohydrate source and 20 kcals/ounce
- Marketed as transition or alternative to whole milk, but no evidence of benefit
IV. Management: Feeding Timing
- Normal frequency: 6 or more feedings per day
- Normal feeding time per bottle: 20-30 minutes
- Short feeding time: <15 minutes
- Consider purchasing nipple with smaller holes
- Long feeding time: >35 minutes
- Consider increasing nipple hole size
V. Management: Formula Preparation
- Heating formula
- Formula only needs to be room Temperature
- Mix formula after heating, test against parent's skin
- Use formula immediately after preparation
- Discard any unused formula in bottle
VI. Management: Sanitation of bottles
- Carefully wash all bottles and nipples before use
- Use only hot, soapy water (no need to sterilize)