Formula Feeding FAQs: Some Common Concerns

Whether you plan to formula feed your baby from the start, want to supplement your breast milk with formula, or are switching from breast milk to formula, you probably have questions.

Here are answers to some common questions about formula feeding.

Is it Normal for My Baby to Spit Up After Feedings?

Sometimes, babies spit up when they have eaten too much, burp, or drool.

Many infants will spit up a little after some — or even all — feedings or during burping because their digestive tracts are immature. That's normal.

As long as your baby is growing and gaining weight and doesn't seem uncomfortable with the spitting up, it's OK. The amount of spit-up often looks like more than it actually is.

But spitting up isn't the same as forcefully vomiting all or most of a feeding. Vomiting is a forceful ejection of stomach contents. Spitting up is a more gentle flow out the mouth or nose.

If you're concerned that your baby is vomiting, call your doctor. Keep a record of exactly how often and how much your baby is vomiting or spitting up. In rare cases, there may be an allergy, digestive problem, or other problem that needs medical care. The doctor should be able to tell you if it's normal or something of concern.

How Can I Keep My Baby From Spitting Up?

If the doctor says your baby's spitting up is normal, here are some things you can do to help lessen it:

• Burp your baby after your little one drinks 1–2 ounces from a bottle.
• Don't give the bottle while your baby is lying down, and keep your baby’s head above their feet.
• Keep your baby upright after feedings for at least 30 minutes. Holding your baby is best. The way your baby sits in an infant seat can make spitting up more likely.
• Don't jiggle, bounce, or actively play with your baby right after feedings.
• Make sure the hole in the nipple is the right size and/or flow for your baby. For example, fast-flow nipples can make babies gag or may give them more milk than they can handle at once. Many breastfed babies do well with a slow-flow nipple until they are 3 months old, or even older.
• Raise the head of your baby's crib or bassinet. Roll up a few small hand towels or receiving blankets (or you can buy special wedges) to place under (not on top of) the mattress. Never use a pillow under your baby's head. Make sure the mattress doesn’t fold in the middle, and that the incline is gentle enough that your baby doesn’t slide down.

Most babies grow out of spitting up by the time they're able to sit up.

How Do I Know If My Baby Has an Allergy?

Some babies are allergic to the protein in cow's milk formula. Symptoms of an allergic reaction may include:

• vomiting
• diarrhea
• belly pain
• rash
• blood or mucus in the baby's poop

If your baby has any of these symptoms, tell your doctor. Also talk to the doctor before switching formulas.

If your baby has symptoms of a severe allergic reaction — like sudden drooling, trouble swallowing, wheezing, or breathing problems — see a doctor right away.

Is Soy Formula Safe for My Baby?

Store-bought iron-fortified soy formula is safe and nutritionally complete. Doctors usually recommend soy-based formulas if:

• Parents don’t want their babies to eat animal protein. 
• A baby has congenital lactase deficiency, a rare condition where babies are born without the enzyme needed to digest lactose. Lactose is the main sugar found in cow’s milk.
• A baby is born with galactosemia, a rare condition where babies can’t digest galactose. Lactose is made up of glucose and galactose. 

Many babies who are allergic to cow's milk also are allergic to the protein in soy formulas, so doctors usually recommend hypoallergenic formulas for these infants.

Soy formula is a good alternative to cow's milk formula for full-term babies (those born at 39 weeks or later). Soy formulas are not recommended for premature babies. Talk to your doctor if you are considering a soy-based formula for your baby.

Do not try to make your own formula at home. Online recipes may look healthy and promise to be nutritionally complete, but they can have too little — or too much — of important nutrients and cause serious health problems for your baby.

Is it OK to Switch to a Different Formula?

It’s probably OK to switch brands of the same kind of formula. For example, parents might buy another brand of cow’s milk formula because it’s on sale or to see if it helps with constipation, or switch to an organic formula because they’re concerned about pesticides.

But before switching formulas, talk to your doctor. Some parents may think that formula plays a part in a baby's fussiness, gas, spitting up, or constipation. But that’s not usually the case. Your doctor can help find out what may be causing these symptoms and recommend the right formula for your baby.

Do I Need to Give My Formula-Fed Baby Vitamins?

No. Commercial infant formulas with iron have all the nutrients your baby needs. Babies who are drinking less than about 1 quart (1 liter) of formula will need a vitamin D supplement.

Does My Baby Need Fluoride Supplements?

Babies do not need fluoride supplements during the first 6 months. Your doctor may recommend fluoride supplements when your baby is 6 months to 3 years old, but only if fluoride is not in your drinking water.

Is it OK to Prop a Bottle in My Baby's Mouth?

Never prop your baby’s bottle. Your baby can choke drinking from a propped bottle. Propping a bottle also can lead to ear infections and tooth decay. Always stay with and hold your baby during feedings.

It is OK to Let My Baby Sleep With a Bottle?

Never put your baby to bed with a bottle. Like propping a bottle, sleeping with a bottle can cause choking, ear infections, and tooth decay.