The major health organizations - including the American Academy of Pediatrics (AAP), American Medical Association (AMA), the American Dietetic Association (ADA), and the World Health Organization (WHO) - agree that breast milk is the ideal form of nutrition for babies (especially during the first 6 months). However, it's every couple's choice to decide what's best for them and their babies. And commercially prepared formulas are designed and strictly regulated to provide the nutrients your baby needs.

Whether you've decided to formula feed your baby from the start, are supplementing your breast milk with formula, or are switching from breast milk to formula, you're bound to have questions. Here are answers to some common inquiries about formula feeding.

Is it OK to prop a bottle in my baby's mouth?

No. You shouldn't leave your baby unattended or feeding from a "propped" bottle. This is a choking hazard. Always hold your baby during feedings.

My baby likes to go to sleep with a bottle. Is that OK?

No. You should never put your baby to bed with a bottle. Not only is this a choking hazard, but formula (as well as breast milk or juice) also pools in your baby's mouth, which can lead to baby bottle tooth decay (a serious dental condition) in older babies and toddlers.

Could my baby have an allergy?

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

• vomiting
• diarrhea
• abdominal pain
• rash
• even some blood in the baby's stools

In some cases, a baby is lactose intolerant. This means the baby can't completely digest the sugar lactose, which is in cow's milk formulas. Symptoms of lactose intolerance may include:

• excessive gas
• abdominal swelling and pain
• diarrhea

Report any of these symptoms to your baby's doctor, and follow his or her advice on switching to a soy-based or special hypoallergenic formula. But even if the doctor suspects a milk allergy, don't spend too much time worrying that your child might be allergic forever. Oftentimes, babies outgrow a milk allergy by 2 or 3 years of age.

My doctor has recommended that I give my baby soy formula. But is it as healthy as cow's milk formula and is it safe?

Most doctors usually recommend giving babies cow's milk formula unless there seems to be an allergy or intolerance, in which case the doctor may recommend soy or hypoallergenic formula. Soy formula - with added iron - contains the nutrients your baby needs; however, some parents may worry after hearing or reading about certain soy concerns, particularly aluminum and phytoestrogens found in soy formulas.

Soy formula should be used under the direction of your child's doctor, but studies have indicated that it is a safe and healthy alternative to cow's milk formula for full-term infants. However, it may not be as beneficial for premature infants. Specific concerns regarding phytoestrogens and aluminum in soy formulas have not been shown to be warranted given that no harmful effects on the growth and nutrition of full-term infants have been found.

Do I need to give my formula-fed baby vitamins?

No. Commercial infant formulas are manufactured to contain all the nutrients your baby needs. However, if you're using one that doesn't contain iron, you should talk to your child's doctor about an iron supplement, probably after your little one is 4 months old.

Does my baby need to take fluoride supplements?

The AAP states that infants - whether breastfed or formula-fed - do not need fluoride supplements during the first 6 months. From 6 months to 3 years, babies require fluoride supplements only if the water supply is severely deficient in fluoride. Well water and bottled water, for example, don't contain fluoride. Ask your child's doctor about your little one's needs.

My baby is really fussy, but it may just be gas. Is there anything I can do to help or prevent this?

Your baby's fussiness may or may not have anything to do with gas or the formula, nipple, or bottle you use. Some babies are simply colicky (continuously crying for long periods of time), especially during the first 2 to 4 months.

There are many possible causes of colic, but doctors now believe that colic is probably not caused by gas. Research suggests that more often than not, colicky babies develop gas by swallowing too much air while they're crying.

If your baby does seem to be passing gas or burping a lot, here are some things you can do that may help ease the gas pains and comfort your little one:

• Walk with your baby or sit in a rocking chair, trying various positions.
• Try burping your baby more often during feedings.
• Place your baby belly-down across your lap and rub his or her back.
• Put a warm towel or warm water bottle on your baby's belly, checking first to make sure it's not too hot.
• Hold your baby upright.
• Put your baby in a swing - the motion may have a soothing effect.
• Put your baby in an infant seat in the back of the car and go for a ride. The vibration and movement of the car often calm a baby.
• Try playing music - some babies respond to sound as well as movement.
• Try giving your baby anti-gas (or simethicone) drops, which may help.

Sometimes, fussiness and gas may be a sign of milk allergy or lactose intolerance. But be sure to talk to your child's doctor first before switching your baby's formula. Let the doctor know how your baby is acting so that he or she can rule out any other possible causes.

Is it normal for my baby to spit up after feedings?

Sometimes, babies spit up when they:

• have eaten too much
• burp (the notorious "wet burp")
• drool

Many infants will spit up a little after eating or during burping because their digestive tracts are immature. That's perfectly normal. But spitting up isn't the same as vomiting all or most of a feeding.

If you're concerned or your baby is vomiting (that is, forcefully vomiting much of a feeding) more than once a day, call your child's doctor. In rare cases, there may be an allergy, digestive problem, or other problem that needs medical attention.

It also may help your doctor to properly diagnose the problem (if there is one) if you keep a record of exactly how often and how much your baby seems to be spitting up. He or she should be able to tell you if it's normal or something that's cause for concern.

But again, it's important to remember that spitting up is usually perfectly OK. If the doctor says your baby's spitting up is normal, here are some things you can do to help alleviate it:

• Burp your little one every 3 to 5 minutes during feedings.
• Don't give your baby a bottle lying down.
• Keep your baby upright after feedings - putting him or her in an infant seat, stroller, or swing afterward.
• Don't jiggle, bounce, or actively play with your baby right after feedings.
• Make sure the nipple hole in your baby's bottle is the right size for your baby. For example, fast flows may cause babies to gag or may simply give them more than they can handle, whereas slower flows may be frustrating to some babies and may cause them to suck more vigorously and gulp too much air.
• Keep your baby's head above his or her feet while feeding (in other words, don't hold your baby in a dipped-down position when feeding).
• Raise the head of your baby's crib or bassinet. Roll up a few small hand towels or receiving blankets (or buy special blocks) to place under (not on top of) the mattress. But don't use a pillow under your baby's head.

Also, keep in mind that many babies grow out of spitting up by the time they're sitting up.

I'd like to switch my baby's formula. How can I make the transition from one formula to another?

Before making the decision to switch, be sure to talk to your child's doctor. Parents often assume that formula plays a part in a baby's fussiness, gas, spitting up, or lack of appetite. But often that's not the case.

If your child's doctor says it's OK to switch formulas, he or she will likely recommend a way to do it so that your baby's feedings and digestion aren't interrupted. The doctor may suggest mixing the two formulas together little by little, then eventually eliminating the original formula altogether.

Reviewed by: Barbara P. Homeier, MD
Date reviewed: August 2005