Dr. Greene's Answer
Many parents share your concern, and this is a common question for pediatricians. By the time that you are juggling multiple feedings and formula or breast milk, an uneasy feeling often develops that something is getting lost in the mix. When mealtime comes, which do you feed first, formula or solids? Or should the formula be given between meals, and how much?
How much milk? How often?
It all starts fairly simply:
- Most healthy formula-fed newborns take 2 or 3 ounces of formula per feeding, and eat every 3 or 4 hours.
- By one month of age, most have increased on their own to about 4 ounces every 4 hours.
- By six months, the amount at each feeding has increased to 6 or 8 ounces, but the frequency has dropped to 4 or 5 times a day. By timing these larger feedings while you are awake, your baby often won’t need to eat in the middle of the night.
Another way to express this rule of thumb is that the average baby takes 2 or 3 ounces of formula each day for every pound of body weight, up to a maximum of 32 ounces. A newborn weighing 7 lbs. will take an average of 14-21 ounces of formula in a day. A 4-month-old weighing 14 pounds needs 28-32 ounces.
Nevertheless, these are general guidelines. In real life, this may vary quite a bit from day to day and from baby to baby. It’s best to remain flexible and to let your baby’s appetite guide the amount. Do not worry too much about calculating the exact number of ounces per feeding or per day. You don’t need to coax him to finish a bottle, or stop him if he still acts hungry. Doing so can actually override your baby’s natural hunger and satiety mechanisms. In general, babies will eat/drink when hungry and stop when full. It is this natural instinct that allows for proper growth and development. At each doctor visit, your pediatrician will check your baby’s growth. If there are concerns, your pediatrician may discuss alternative feeding plans. If you notice your baby refusing food, losing weight, or you are unsure about their growth, please make a visit with your pediatrician to discuss your concerns.
What about breastfeeding?
Moms who breastfeed are often worried because they can’t see or measure how much their babies are eating. As discussed above, babies are born with a sophisticated mechanism that prompts them to nurse until they are full and to stop when their nutritional needs are satisfied. If a mother is not producing enough milk, a healthy baby will act hungry even after feeding and will not gain weight normally. This will be seen at your doctor visits during the weight check. This is one of the reasons even healthy babies see their pediatrician so often. We like to make sure they are growing well! The pediatrician should be called if there are any concerns about growth.
What about starting solids?
When a baby is still hungry after 32 ounces or nursing 8-10 times, it may be time to start solid foods. Typically, this occurs sometime between 4 to 6 months of age.
There are several other indicators that your baby is ready to start solid foods. First, note that the American Academy of Pediatrics (AAP) recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. In addition, they advise that most babies are ready to start solid foods when they reach the following milestones:
- They can sit in a high chair or feeding chair and hold their head upright.
- They can open their mouths as food comes their way.
- They can move food from their mouth to their throat.
- They are approximately double their birth weight and over 13 pounds.
It’s usually best to start with solids once or twice a day and to finish each meal with nursing or a bottle. Some babies prefer a little formula first to take the edge off their hunger. It is hard to concentrate on learning how to eat if they are too hungry! Babies can have as much of the solids as they want. In reality, the number of calories they are getting from solids at this age is very minimal; therefore it is still important to keep their schedule of milk feedings.
At this stage, most of their nutrition still comes from breast milk or formula. The solids provide a wonderful experience with flavors, textures, and the mechanics of eating, and learning to eat is an important milestone in this first year of life. As the amount of solids they take increases, most babies settle into a pattern of 3 meals of solids each day, but again there may be quite a bit of individual variation in this schedule The amount of formula tends to drop off a bit, but typically still falls in the range of 6 to 8-ounce bottles given 3 to 5 times a day. Most commonly, a smaller bottle (or half a bottle) is given with each meal and a larger one at bedtime. Some babies also enjoy a bottle first thing in the morning.
How much milk do older babies need?
An older baby can have up to 32 ounces of formula per day. In addition, he can have as much in the way of solids or water as he wants to supplement this. The mealtime formula is usually given at the end of the meals, to top off the solids in a comfortable and easy way. Even though the solids are now playing a larger role, the breast milk or formula still provides the core of the nutritional needs.
Thirst is an extremely strong drive. As long as a baby’s own regulating mechanism isn’t tricked by getting too much juice or water, healthy babies will take enough formula or breast milk to meet their nutritional needs. This is one good reason not to put juice or water in the bottle.
The AAP and most pediatricians do not recommend feeding your baby any juice at all before the age of 12 months. After one year, kids still don’t need juice, but any juice should be limited to less than 6 ounces a day using only 100% fruit or vegetable juice.
Water is only recommended for those babies over 6 months and in small amounts. A good rule of thumb is to limit the daily ounces of water to the age of a baby in months (for example, a 6-month-old can have up to 6 ounces of water). Water can be served in an open or sippy cup.
Let your baby set the pace, but if he continues to consistently take more than 32 ounces or less than 20 ounces, bring your baby in to see their pediatrician for a feeding discussion and weight check.
Within these broad guidelines, there is plenty of room for different preferences and schedules. Variety is part of life. Your baby and your own intuition are good guides through these exciting times.
References and Resources
Lyons KE, et al. Breast Milk, a Source of Beneficial Microbes and Associated Benefits for Infant Health. Nutrients. 2020 Apr 9;12(4):1039.
Nuzzi G, et al. Breast milk: more than just nutrition! Minerva Pediatr (Torino). 2021 Apr;73(2):111-114.