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Milk and milk drinks marketed for children 1-4 years in the UK

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Milk and milk drinks marketed for children 1-4 years in the UK

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Animal milks

This paper outlines current dietary guidelines for milk consumption among young children in the UK, the contribution of animal milk to the dietary intakes of children aged 1-4 years, and revisits the recommendations on what types of animal milk children of different ages should drink and why, as well as how much.

Drinks marketed as growing-up and toddler milks

This paper focuses on infant milks labelled as stage 3 and stage 4 formulas, and marketed for use in the second and third year of life. It highlights the lack of compositional, marketing or labelling regulations for these unnecessary, ultra-processed drinks, and their high cost and high free sugar content.

Milk FAQs

Some common questions regarding milk and milk drinks for children aged 1-4.

Plant-based milk alternatives

This paper provides an overview of milk alternatives made from soya, oat, pea, hemp and different nuts. Information is provided on the nutritional composition of selected products compared to cows' milk, and on the potential health benefits and risks associated with their use for young children as alternatives to cows' milk.

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Milks marketed for children - First Steps Nutrition Trust

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This paper outlines current dietary guidelines for milk consumption among young children in the UK, the contribution of animal milk to the dietary intakes of children aged 1-4 years, and revisits the recommendations on what types of animal milk children of different ages should drink and why, as well as how much.

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Cordelia Uys article on responsive bottle feeding

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Cordelia Uys article on responsive bottle feeding

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Babies need to feed frequently:
Babies have evolved to be in close contact with their mothers, and to be fed frequently, day and night.

N.B. Because a baby's rate of growth slows down as they get older, the volumes of breastmilk babies need between one month and 6 months don't increase very much.
Volumes of formula milk after the first week:
NCT Breastfeeding Counsellor Heather Welford, author of 'Successful Infant Feeding', says:

" Formula fed babies can't be expected to take a pre-determined amount of milk at every feed, and the guidance amounts on every formula pack should be used very flexibly. Your baby is your best guide. A rule of thumb is to expect your baby to take something like 150g per kilo of body weight in a 24 hour period. But in practice, healthy babies may have more or less that this." Of course in the first couple of weeks, a baby will be taking considerably less than this.

The following is from Shel Banks's book 'Why Formula Feeding Matters':

" We talk about babies' needs increasing from nil to about 580ml by the middle of week two of life, and then up to around 750ml by the end of week two. This may then rise very slowly over the next 5-6 months, up to around 900ml - but these are massive generalisations, and will vary from baby to baby. Most babies required roughly 150-200ml of formula per kg of the baby's weight each day after around two weeks of age, until solid food is introduced at around six months."

Victorian advice has led to long feeding intervals becoming the norm:
Since the publication in 1894 of a very influential book by the paediatrician Emmett Holt, who advocated long feeding intervals and virtually no night feeding, the majority of parents in Western society have been trying to get their babies to behave in ways which aren't physiologically appropriate. This is reflected in the advice on feeding frequency commonly given by formula manufacturers, who recommend feeding babies 5 times in 24 hours from the age of 2 weeks. This advice leads to babies being fed larger volumes than they can comfortably fit in their tummy and going long gaps between feeds.

Most adults eat and drink at least 8 times in 24 hours:

For babies, milk is both food and drink. How can it be right to recommend only feeding a baby 5 times in 24 hours when most adults are eating and/or drinking at least 8 times in 24 hours, even though, unlike our babies, we aren't trying to double our weight in 4 months? Many of us will actually be eating and drinking much more often than 8 times, especially if it's a warm day, or we've been exercising.

Babies are able to self-regulate:

Babies have a natural ability to self-regulate: as long as they're in control, they will stop feeding as soon as they are full. Breastfed babies can't be overfed because they are in control - you can't force a baby to breastfeed if they don't want to.

Bottle-feeding puts babies at risk of overfeeding:

If you bottle-feed a baby while holding them in a reclined position, a combination of gravity and the baby's sucking reflex means it's easy to persuade them to drink more milk than their tummy can comfortably fit. We have all evolved to want to get as much food into our babies as possible, so the temptation to overfeed is strong.
Overfeeding puts babies at risk of becoming overweight later on:
The problem is that when babies are regularly fed large volumes of milk, it stretches their stomach, which can affect their ability to self-regulate and puts them at risk of becoming overweight. At the moment, in the UK, more than 1 in 5 children are overweight or obese when they begin primary school. It has been estimated that in at least 20% of cases, this is due to being overfed via the bottle as babies.
Responsive feeding protects from overfeeding and is kinder:
UNICEF is strongly encouraging parents who bottle-feed their babies to do so responsively, whether the bottle contains breastmilk or formula, because this protects the baby's ability to self-regulate, and because it's much kinder. Making a baby wait for a feed is stressful and upsetting and raises their stress hormone levels.
What is responsive feeding?

Feeding your baby as soon as he or she shows any signs of hunger.

Early feeding cues include: mouth opening, head turning, rooting, putting hand to mouth and stretching.

Crying is a late feeding cue: it's best to feed babies before they're desperate.

Pacing feeds.

Following your baby's lead in how much milk they drink. It's fine for the volumes they drink to vary from feed to feed.

Not trying to get your baby to finish the bottle.

Paced bottle feeding:

Paced bottle feeding makes bottle-feeding responsively much easier. Rather than holding your baby in a reclined position, hold them upright and close to your body, and hold the bottle horizontal with the floor. The teat should only be half full of milk. Pause every 30 seconds or so by pulling the bottle down to vertical. Bring the bottle back up to horizontal once the baby starts to suck again. Stop feeding as soon as your baby no longer sucks/seems interested. https://www.youtube.com/watch?v=TuZXD1hIW8Q
Limit the number of people who feed your baby:
It's recommended to limit the number of people who feed your baby to no more than 2 or 3. Your baby needs to be familiar with the person feeding them, so they feel safe and relaxed. This is what the NCT says: " Babies build up trust and confidence during feeding, gradually learning what to expect. This is partly how they develop healthy emotional and social attachment. In the early weeks and months, it might help to keep most of your baby's bottle-feeds for you and your partner, or one other trusted person.

If someone else is bottle-feeding your baby, talk to them about how you feed your baby so there's some consistency. "
Switch sides
Switching the baby so that you are feeding him or her with your non-dominant hand half-way through the feed will help their physical development. Breastfed babies usually have the experience of feeding on both sides and facing different directions during a feed.
Links:
https://www.nct.org.uk/baby-toddler/feeding/early-days/how-bottle-feed-your-baby
https://www.bookdepository.com/Care-Feeding-Children-L-Emmett-Holt/9781497391604 https://www.lllc.ca/thursday-tip-newborns-have-small-stomachs https://www.theguardian.com/society/2015/may/07/one-quarter-british-children-overweight-obese-study https://www.gov.uk/government/publications/childhood-obesity-applying-all-our-health/childhood-obesity-applying-all-our-health https://www.theguardian.com/lifeandstyle/2010/sep/30/bottle-feeding-babies-adult-obesity https://www.parentingscience.com/stress-in-babies.html https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2017/12/Responsive-Feeding-Infosheet-Unicef-UK-Baby-Friendly-Initiative.pdf https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2019/04/Infant-formula-and-responsive-bottle-feeding.pdf https://youtu.be/OGPm5SpLxXY

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Babies need to feed frequently: Babies have evolved to be in close contact with their mothers, and to be fed frequently, day and night. N.B. Because a baby's rate of growth slows down as they get older, the volumes of breastmilk babies need between one month and 6 months don't increase very much.

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Cordelia Uys article: 'Everything you need to know about infant formula':

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Cordelia Uys article: 'Everything you need to know about infant formula':

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The World Health Organisation and the NHS recommend exclusive breastfeeding for the first six months of a baby's life, and continued breastfeeding, alongside the gradual introduction of solids foods, for as long as the mother wishes. Where parents cannot, or choose not to breastfeed, breastmilk substitutes, in the form of infant formula milk, are available.
First Steps Nutrition
The public health charity First Steps Nutrition is the best source of independent, evidence-based information on infant formula milks.
First Stage Infant Formula from 0 to 12 months
The majority of infant formula milks are made from cow's milk that has been modified to make it suitable for babies. Although there are many types of formula available, the WHO and the NHS recommend First Stage formula (also called First Milk or Stage 1 Milk) for the first 12 months of a baby's life.

From 12 months onwards, infants can drink full-fat cow's milk. There is no need for a child over one to be given formula milk.

'Hungry Baby' milks, 'Goodnight' milks and Follow-on milks are not recommended
There are two cow's milk proteins in formula: whey and casein. First Stage formula is based on whey protein, which is believed to be easier for babies to digest. 'Hungry baby' milks and 'Goodnight' milks are harder to digest and not recommended by the NHS or UNICEF. There is no evidence that babies settle better or sleep longer when fed these milks.

Follow-on milks, marketed as being for babies over 6 months, are also not recommended by the NHS. Follow-on milk was invented for advertising purposes, because advertising of First Stage milks is not permitted in the UK. Follow-on milks don't exist in the U.S. where there are no restrictions on advertising formula.
There is no difference in quality between different brands of formula milk
All First Stage infant formula milks are required by law to provide sufficient macro and micro nutrients to support adequate growth, and they must all meet the same compositional standards. Any additional ingredients claimed by an individual brand are just a marketing ploy: if one particular formula milk contained an ingredient proven to be beneficial to babies, then all formula milks would have to contain it. It's therefore pointless spending lots of money on an expensive brand.
Dispatches documentary on Channel 4
In 2019, the Channel 4 documentary programme Dispatches highlighted the enormous discrepancy in price between various brands of formula.

Sainsbury's Little Ones formula - £175.99 buys six months of formula

SMA Pro First Formula - £175.99 buys three and a half months of formula

Aptamil Profutura Stage 1 - £175.99 bus two and a half months of formula

Pre-mixed bottles of Aptamil Profutura - would cost £789.31 for six months.

Powdered infant formula is not sterile
Many parents are not aware that powdered infant formula is not sterile and may contain pathogens. The biggest risks are from Cronobacter sakazakii and Salmonella, both of which can make babies very ill. It is therefore essential for bottles made using powdered formula to be prepared carefully, with freshly boiled tap water that then needs to be allowed to cool to no less than 70C before formula powder is added. If the water is cooler than 70C when the formula powder is added, any pathogens in the milk might not be killed.

Please follow NHS guidelines for making up bottles of powdered formula very carefully:

https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2008/02/start4life_guide_to_bottle_-feeding.pdf

Any formula left-over after a feed should be discarded within an hour. Formula that has not been used and has been kept at room temperature must be thrown away within two hours.
Bottled water is not recommended for making up bottle feeds
Bottled water is not recommended for making up feeds as it is not sterile and might contain too much salt or sulphate. Below is a photo of page 46 from 'Why Formula Feeding Matters' by Shel Banks.

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The World Health Organisation and the NHS recommend exclusive breastfeeding for the first six months of a baby's life, and continued breastfeeding, alongside the gradual introduction of solids foods, for as long as the mother wishes. Where parents cannot, or choose not to breastfeed, breastmilk substitutes, in the form of infant formula milk, are available.

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Shel Banks has written a detailed, evidence-based guide to formula feeding

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Shel Banks has written a detailed, evidence-based guide to formula feeding

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Shel Banks is an IBCLC and NHS infant feeding specialist based in Lancashire, England, and is a mother with four adolescents.

She is also Vice Chair of the charity UK Association for Milk Banking which supports milk banks in the provision of donor human milk for the most vulnerable babies, and Chair of LIFIB, which has been providing evidence based information about formula and bottle feeding to health professionals since 2008.

Shel has a great interest in evidence based practice and the fully informed choice of expectant and new parents, and has contributed to 3 NICE Guidelines (Donor Milk Banking, Postnatal Care and Faltering Growth) and co-authored 3 Cochrane Systematic Reviews on various aspects of Infantile Colic. She is looking forward to working further on this from 2022 onwards as she delves deeper into the management of unsettled babies, during her doctoral studies.

She has a small private practice specialising in unsettled babies, disturbed sleep, formula feeding and faltering growth, and as a tutor for health and social care professionals in the UK and across the world.

Alongside teaching and coaching families and health professionals, Shel has also had a number of TV and radio appearances, including BBC Breakfast and the Channel 4 Dispatches documentary "The Great Infant Formula Feeding Scandal".

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Why Formula Feeding Matters (Pinter & Martin Why it Matters: 23)

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Why Formula Feeding Matters (Pinter & Martin Why it Matters: 23) : Shel Banks: Amazon.co.uk: Books

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The Royal College of Midwives says: "Powdered formula is not sterile (Crawley et al, 2011) and may contain bacteria such as salmonella and enterobacter sakazakii. It is important to use boiled water at the correct temperature in order to kill the bacteria and protect against illness and infection (Hormann, 2010)."

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The Perfect Prep machine might not be safe: 

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The Perfect Prep machine might not be safe: 

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Dispatches investigates the infant formula industry

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Dispatches investigates the infant formula industry

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THE GREAT FORMULA MILK SCANDAL: CHANNEL 4 DISPATCHES Monday 18th March, Channel 4, 8pm Channel 4 Dispatches asks if the £40billion infant formula industry is putting profit before babies? Key lines:

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Impartial information on infant milks for parents and carers: 

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Impartial information on infant milks for parents and carers: 

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The different types of infant formula, and other infant milks, marketed for babies and young children can seem confusing when you see lots of different ones on the supermarket shelf, but the information you need as a parent or carer is really quite simple. The majority of infants who are formula fed or mixed fed should be given a first infant milk (sometimes called first stage or stage 1 milk) throughout the first year.
All infant formula on the UK market must meet compositional regulations, so all products are perfectly ok to feed a baby. More expensive brands still have to meet the same compositional standards as cheaper brands. In this section you will find answers to questions you may have about infant formula (or other infant milks) and some information on making up infant formula safely and responsive bottle feeding. More detailed information can be found in the infant milks section for health workers.

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Infant milks for parents & carers - First Steps Nutrition Trust

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The different types of infant formula, and other infant milks, marketed for babies and young children can seem confusing when you see lots of different ones on the supermarket shelf, but the information you need as a parent or carer is really quite simple.

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La Leche League info on formula supplements

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La Leche League info on formula supplements

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Babies sometimes need more milk than they can take at the breast. This may be because they were born early or small, and don't yet have enough energy to do all the work of breastfeeding. Sometimes, mothers don't have as much milk as their baby needs. It is important that babies get enough milk to be healthy and to grow normally.

La Leche League groups welcome anyone who is breastfeeding or providing their own milk for a baby, or trying to do so. Please don't feel awkward about needing to give your baby extra milk at an LLL meeting! We would love to meet you and your baby!

Get support from LLLGB here.

Why a baby might need extra milk
How to tell if your baby is getting enough milk
Normal growth
Why protecting the milk supply is urgent
Why a mother might not be able to make a full milk supply
Giving extra milk - what kind of milk
Mothers' feelings about using formula milk
Extra milk - how to give it
Extra milk - when to give it
Extra milk - how much to give
Reducing the amount of extra milk
What if you need to keep using formula milk?

Why a baby might need extra milk

The most common reason for a baby to need extra milk is a slow start with breastfeeding, when not enough milk was removed from the mother's breasts in the early days after birth. This can happen when a baby is early, small, unwell, very sleepy, or unable to breastfeed at first. It can also happen when a baby isn't taking a deep enough mouthful of breast tissue to breastfeed effectively. In this case, the mother may get sore, damaged nipples and the baby may seem unhappy and unsatisfied, never wanting to let go of the breast. When not enough milk is removed, the mother's milk supply doesn't get a strong enough signal to increase to the level the baby needs.

You can read more about this here: My baby needs more milk.

How to tell if your baby is getting enough milk

When young babies aren't getting as much milk as they need, the first sign is usually that they don't poo as much as expected. A baby over 3 days old who isn't doing at least 3 yellow poos - the size of a 2p coin or larger - every 24 hours needs to be checked by a healthcare provider. After about 6 weeks, babies find their own pooing pattern, which may be less often. As long as the baby is well and growing normally, it doesn't matter by this stage how often they poo.

Weight loss is another important way to tell whether a baby is getting enough milk. Babies usually lose up to 7% of their birth weight in the first 3-5 days after birth. If they lose more than this, or keep losing weight after day 5, they need to be checked by a healthcare provider.

You can read more about this here (is my baby getting enough milk?) and here (what's in a nappy?).

Normal growth

Babies usually get back to their birth weight by 10-14 days after birth. In the first 3-4 months of life, boys grow at an average of about 40g a day, and girls at an average of 34g a day. A baby who puts on less than 30g a day on average, or whose growth curve drops down across more than one "centile line" on their weight chart, needs to be checked by a healthcare provider.

Why protecting milk supply is urgent

Whatever the reason, when a baby isn't taking as much milk as she needs at the breast, the mother's milk supply may not increase enough to meet all the baby's needs. Milk supply usually increases quickly in the early days after birth, reaching its peak level by the end of the first month. Most of this increase happens in the first 2 weeks, so the amount of milk that is removed at this time is really important. If too little is removed, it may limit how much milk a mother can make later.

When breastfeeding is going well, a baby nursing at the breast will remove milk much more effectively than any breast pump. However, if your baby isn't breastfeeding at all yet, or isn't taking as much milk as he needs at the breast, it is important to start expressing your milk as soon as possible. This will ensure that your body gets the signal it needs to make more milk. Babies who are not breastfeeding effectively may want to spend a lot of time at the breast, so it can be difficult to find time to express milk. Given the importance of protecting your milk supply at this stage, it may be necessary to limit the baby's time at the breast to free up enough time to express. This is an investment of time to make sure you have enough milk later. Find good breastfeeding support as soon as possible.

You can read more about expressing and storing milk here.

Why a mother might not be able to make a full milk supply

Occasionally, a mother may have a medical history or health issues which limit the amount of milk she can make. These reasons can include:

A history of infertility due to hormonal imbalances

Past breast surgery, especially breast reduction

Breast hypoplasia/Insufficient Glandular Tissue (IGT) - breasts may be unusually small, unevenly-sized, long and thin, with a wide space between them and there may be no breast changes (such as increase in size and tenderness) during pregnancy

PCOS (polycystic ovary syndrome)

Thyroid problems (over- or under-active)

Obesity (BMI over 30)

If any of these apply to you, you may still be able to make milk normally. However, if your breastfed baby isn't growing well it is important to find good breastfeeding support quickly.

Giving extra milk - what kind of milk

The first choice when extra milk is needed is your own expressed milk, which is tailor-made for your baby. The second choice is donated milk from another mother. This may be available from a Milk Bank if your baby is still in hospital.

You can read LLL's policy on informal sharing of breastmilk here.

When none of these is available in the amounts needed, infant formula milk may be necessary. If you are not sure what kind of formula milk to use, check with your midwife or health visitor. You can find independent information about infant milks in the UK here.

Mothers' feelings about using formula milk

When you were looking forward to breastfeeding your baby, it can feel disappointing to realise that he needs formula milk as well. You might even wonder whether it is worth carrying on breastfeeding, or whether your baby will come to prefer formula milk. It can help to think of formula milk as a kind of medication, to give your baby the energy he needs to breastfeed well. Babies are "hard-wired" to breastfeed and even a small amount of breastmilk can have a significant positive effect on health outcomes that no formula can provide. Even if your milk supply is very low, you and your baby can still enjoy the cuddly, calming, comforting aspects of breastfeeding, for as long as you want to. Breastfeeding is about much more than just milk!

Extra milk - how to give it

There are several options for giving extra milk to a baby.

In the first 1-2 days after birth, when the baby needs small amounts, a teaspoon can work well. You could express your own milk directly into the spoon and use it to feed the milk to your baby. On day 1 after birth, a full feed is about 7ml (1 ½ teaspoons), on average. On day 2 after birth, this doubles to about 15ml (3 teaspoons) per feed. Newborns need at least 8-12 feeds in 24 hours.

By day 3, something larger is needed. Cup-feeding can work well, with practice. You can use any clean cup - a small one, such as a shot glass, can work well. Trying to feed your partner or support person with a cup of water and having them feed you in return can help you quickly learn how far to tip the cup so that your baby can sip from it.

A nursing supplementer (also known as a lactation aid) is a tool that lets you feed extra milk (either expressed milk or formula milk) while your baby breastfeeds. It can be useful if you want to breastfeed but don't have enough milk. The extra flow of milk can encourage your baby to breastfeed. You can read more about supplementers here.

If bottles are used, it is important to know how to use them in a way that supports breastfeeding. It is easy to feed a baby too much, too fast by bottle, and this can be unhelpful for a baby who is finding breastfeeding difficult. You can find out how to do "paced" bottle feeding - at a good speed for your baby, letting him choose how much to take - here.

Extra milk - when to give it

It is often suggested that you breastfeed first, before giving the extra milk. This often means that the baby is at the breast when he is hungry and least happy, which can make breastfeeding stressful for both of you.

An alternative might be to try ending feeds with your baby at the breast. This may mean starting with some extra milk, to calm your hungry baby enough to help him breastfeed. Or you could start with one breast, give the extra milk in the middle, and finish on the second breast. It's much nicer for your baby to fall asleep at your breast than with a cup or bottle!

Even if your baby isn't breastfeeding much or even at all yet, spending happy time being at or near your breast will make it easier for him to breastfeed when he is ready. Carrying your baby in a sling, cuddling him skin-to-skin, taking a bath together and lying down together in a prepared bed ( if it is safe for you and your baby to do so) are all good ways for him to spend relaxed time at the breast. Babies who feel comfortable at the breast are more likely to try breastfeeding when they are ready. You might like to give the extra milk with your baby's cheek resting on your breast, letting him fall asleep on the breast as he finishes.

Extra milk - how much to give

Healthy, full-term babies are usually very good at knowing how much milk they need. If you are giving extra milk by cup or bottle, carefully watch your baby for signs that he wants more or has had enough. Your baby can show you how much they want.

Sometimes, though, a baby is so early, unwell or sleepy that they are not able to ask for as much as they need. A baby who has been getting less milk than he needs for a while may act as if he is not hungry, because he doesn't have much energy. He may look as if he is finished after a very short feed, but he will not be pooing or growing as expected.

When this happens, it is important to encourage the baby to take more milk. Keep your baby close, doing skin-to-skin as much as you can. This will encourage your baby's interest in feeding, and help you to notice the first signs that he is waking up and getting ready to feed. Your baby may only be able to feed for a short time, so he needs to do it very often. Feeds don't have to be equally spaced, but they need to happen at least 8-12 times in 24 hours. It can be helpful to record the number of feeds, along with the number of wet and dirty nappies he has done each day.

When your baby is growing and pooing as expected, he is taking as much milk as he needs.

It is important to keep in close touch with your healthcare provider during this time. If your baby starts doing fewer wet nappies, or it is getting more difficult to wake him to feed, please contact your midwife or doctor straight away.

Once your baby starts to take more milk, his energy will increase. He will start to catch up with his growth, and he might want a lot more milk. Don't panic! Give him as much as he wants, making sure that you feed carefully if using a cup or bottle, so that he can stop when he has had enough. Once his growth has caught up with where it needs to be, his appetite will calm down.

Reducing the amount of extra milk

If your goal is to feed your baby only with your milk, you will be wondering how to reduce the amount of donor or formula milk your baby is getting. It is important to work with your healthcare provider and your local breastfeeding supporters to come up with a plan tailor-made for you and your baby.

Read our article on Weaning from Supplements here.

What if you need to keep using formula milk?

Sometimes, however hard you try to increase your milk, your baby might need to keep having some formula milk. This might be an important part of his diet, or even most of it, but remember that breastfeeding is about much more than just milk. If you ask mothers of older breastfeeding babies or toddlers what they and their babies value about breastfeeding, they usually forget to mention milk! They talk about how much their babies enjoy it, how useful it is for calming them down and getting them to sleep, and how restful it can be for the mother to sit or lie down to feed. Breastfeeding can still work really well in all these ways, whether or not the baby is also having some formula milk.

It is sometimes possible to stop using formula milk after the baby has started eating other foods, usually from around 6 months. As your baby eats more food, he will need less milk. It is often possible to reduce the amount of formula he takes while still breastfeeding as much as you like. After a year, babies can drink unmodified animal milk (such as cow's milk or goat's milk) and no longer need formula milk. You can continue to breastfeed for as long as you and your child want to. Many mothers who have needed to use formula milk in the early months of their child's life find that the later months and years of breastfeeding are much more enjoyable, because they no longer need to think about how much milk their child is getting.
Written by Jayne Joyce, LLL Oxfordshire, June 2018

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Using donor milk and formula to support breastfeeding - La Leche League GB

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Babies sometimes need more milk than they can take at the breast. This may be because they were born early or small, and don't yet have enough energy to do all the work of breastfeeding. Sometimes, mothers don't have as much milk as their baby needs.

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by Dr Louise Santhanam, General Practitioner The UK Department of Health and the World Health Organisation (WHO) recommend breastfeeding exclusively for six months, with continued breastfeeding the…

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Volumes of milk in the first week of life: 

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Volumes of milk in the first week of life: 

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In the first week, babies stomachs are very small, but they grow rapidly.

On Day 1, a baby can’t take much more than 5-7ml per feed. Usually newborns will feed 8 to 12 times or more in 24 hours, although on Day 1 a baby might have quite a long sleep after an initial period of alertness immediately after birth.

By Day 2 the baby’s maximum stomach capacity is circa 10ml per feed.

By Day 3, the baby’s stomach has grown enough to take around 22-27 ml per feed

The baby's stomach capacity increases by 10ml per day until it plateaus by Day 7, when babies  take around 45-70ml per feed.

The volumes babies take will often vary from feed to feed. The crucial thing about these voumes is that they reflect the baby’s maximum stomach capacity and your baby might sometimes want less than this per feed. And of course, the volumes also depend on how frequently your baby is feeding. UNICEF talk of an average of 10 to 12 feeds in 24 hours, and recommend no fewer than 8 feeds.

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Volumes of milk after the first week of life: 

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Volumes of milk after the first week of life: 

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My colleague NCT Breastfeeding Counsellor Heather Welford says: "formula fed babies can’t be expected to take a pre-determined amount of milk at every feed, and the guidance amounts on every formula pack should be used very flexibly. Your baby is your best guide. A rule of thumb is to expect your baby to take something like 150g per kilo of body weight in a 24 hour period. But in practice, healthy babies may have more or less that this.”

In the first week, babies will take considerably less than 150g per kilo of body weight

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NHS information on how to safely prepare formula:

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NHS information on how to safely prepare formula:

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How to make up formula milk feeds for your baby correctly and safely.

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Some readers may remember I posted about breastfeeding and bonding here - so I thought I would follow up about how mums not breastfeeding can maximise bonding with their baby.

There are various processes and hormones involved with bonding, but the one we hear most about is oxytocin; often nicknamed the "cuddle hormone". It has been heavily linked with feelings of trust, security, and love - whilst for parents it can influence maternal/paternal behaviour and even drastically reduce the risks of abuse and neglect. It even causes nerve junctions in the mother's brain to reorganise, making her maternal behaviors "hard-wired."

When mum breastfeeds, oxytocin is released - and many who work with breastfeeding mothers have commented it can be observed when feeding is going well. Mums gaze at and preen their babies, playing with baby's ears, toes and fingers, sometimes almost glazing over and losing interest in chatting. It is also oxytocin that causes mum to be so drawn to the smell of her breastfed baby, and many joke their babies are so used to their heads being scattered with kisses, they proffer that for a kiss when they get older! Baby makes his own oxytocin in response to nursing and mum transfers additional amounts in her milk.

All that said, mothers can still fail to bond when breastfeeding - if other factors are in play, perhaps trauma after a difficult delivery or postnatal depression; breastfeeding problems, nipple trauma and so on.... It's certainly no guarantee but more of a massive helping hand along the way.

Oxytocin isn't a hormone exclusive to breastfeeding mums; a large surge happens at the start of labour (which is one of the reasons why many experts now recommend letting labour commence - even if a Caesarean section is planned) and again as baby moves down the birth canal. It is also produced through touch and warmth ie the act of nurturing behaviour and is cyclic - so the more oxytocin is produced, the more you want to nurture, which in turn produces more oxytocin, and so on.

So going back to the breastfeeding mum - breastfeeding increases levels, which provokes nurturing behaviour and in turn more oxytocin. Mum HAS to hold baby to breastfeed, but what about the bottle feeding mum?

I'm sure many of us have been in a cafe and seen the baby still in a pushchair, mum holding bottle with one hand whilst she sits and reads a magazine - perhaps eating her own lunch. Sometimes baby is left to feed themselves entirely with absolutely no contact, and worryingly there is an increasing range of items on the market, designed to facilitate feeding without any human touch or "nurturing behaviour" - at what cost? Well apart from the very obvious choking risk which is why parents in the UK are advised never to prop bottles!

A growing body of scientific evidence shows that the way babies are cared for will determine not only their emotional development, but the biological development of the brain and central nervous system as well. The research also shows mother's love acts as a template for love itself and has far reaching effects on her child's ability to love throughout life. Research conducted at UCLA first months of an infant's life constitute what is known as a critical period - a time when events are imprinted in the nervous system.

"Hugs and kisses during these critical periods make those neurons grow and connect properly with other neurons. You can kiss that brain into maturity"

Dr. Arthur Janov, in his book Biology of Love.

How can bottle feeding mums boost bonding?
Some mums are naturally very maternal - regardless of how they feed, perhaps having higher natural levels of oxyocin, prolactin and other natural morphine-like chemicals. For others bonding is a process that takes time, and there are lots of things bottle feeding mums can do to help boost levels of the several important hormones:

1. Skin to skin - whilst breastfeeding mums are often encouraged to do this for milk supply, it's often not suggested to bottle feeding mums beyond immediately after birth. All mums and babies benefit from this contact on several levels - physically, emotionally and neurologically.

Touch-especially between parent and child- induce opioid release, creating good feelings that will enhance bonding. Prolonged elevation of prolactin in the attached parent stimulates the opioid system, heightening the rewards for intimate, loving family relationships.

2. Hold and cuddle your baby - consider a pouch or sling to keep baby close, the warmth and closeness of baby boosts hormones all round. Regular body contact produces a constant, elevated level of oxytocin in the infant, which in turn provides a valuable reduction in the infant's stress-hormone responses.

2. Feed baby yourself - in the early days when relatives and friends come round, it can be tempting to let them feed baby whilst you get on with other jobs. Swap roles and let them help out with chores as they would for a breastfeeding mum, whilst you relax and spend the time feeding baby.

3. Interact whilst feeding - gaze into your baby's eyes, stroke them, examine their fingers, ears - maximise touch all round. Feeding for a breastfed baby is a full sensory experience, mimicking this when bottle feeding makes the experience more fulfilling for both baby and mum.
One study found:

Oxytocin levels were associated with parent-specific styles of interaction.The levels were higher in mothers who provided more affectionate parenting - including gazing at the infant, expression of positive affect, and affectionate touch (Biological Psychiatry)

4. Bathe with baby - ditch the baby bath and hop in! Warm water and skin contact is a double whammy - dads often love this too.

5. Don't bottle prop! - Really who doesn't have time to pick a baby up and feed them every few hours? Seriously if you don't have this time, do you have time for a baby at all?

A more variable release of oxytocin is seen in bottle-fed infants, but is higher in an infant who is "bottle-nursed" in the parents' arms rather than with a propped bottle.

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Boosting Bottle Feeding Bonding - 5 top tips...

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Some readers may remember I posted about breastfeeding and bonding here - so I thought I would follow up about how mums not breastfeeding can maximise bonding with their baby. There are various processes and hormones involved with bonding, but the one we hear most about is oxytocin; often nicknamed the "cuddle hormone".

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Heather Welford's 'Successful Infant Feeding':

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family & relationships / life stages / infants & toddlers

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health & fitness / pregnancy & childbirth

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While breastfeeding is the natural way to feed an infant, ignorance of the mechanisms, societal pressures and lack of help often force mothers into bottlefeeding and the nurturing experience can become less happy and unfulfilling. There is, therefore a need for information that ensures infants ar...

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How to bottle feed the breastfed baby

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Impartial, evidence-based information on infant milks

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Impartial, evidence-based information on infant milks

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Paced Bottle Feeding For The Breastfed Baby