Dr. Greene's Answer
Many parents share your concern. 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. You don’t need to coax him to finish a bottle, or stop him if he still acts hungry. If your baby consistently chooses to take more or less than the expected amount, discuss this with your pediatrician.
What about breastfeeding?
Moms who breastfeed are often worried because they can’t see or measure how much their babies are eating. 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. The pediatrician should be called if there is concern.
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 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. Babies can have as much of the solids as they want.
At this stage, most of the nutrition still comes from breast milk or formula. The solids provide wonderful experience with flavors, textures, and the mechanics of eating. As the amount of solids they take increases, most babies settle into a pattern of 3 meals of solids each day. 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. If a baby begins to regularly take less than about 20 ounces per day, you might want to offer the bottle first and then solids.
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 in the bottle.
Let your baby set the pace, but if he continues to consistently take more than 32 ounces or less than 20 ounces, run it by your pediatrician.
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.