Breastfeeding is a natural thing to do, but it still comes with its fair share of questions. Here's what you need to know about about introducing formula, solids, and more.

Is it OK to Give My Baby Breast Milk and Formula?

Breast milk is the best nutritional choice for babies. But in some cases, breastfeeding (or exclusive breastfeeding) isn’t possible or an option. What’s best for your baby's health and happiness is, in large part, whatever works for your family. So if you need to supplement, your baby will be fine and healthy, especially if it means less stress for you.

Babies who need supplementation may do well with a supplemental nursing system. This is when moms place a small tube by their nipple that delivers pumped milk or formula while a baby is breastfeeding.

Babies also can get pumped milk or formula by bottle. But it’s a good idea to wait until your baby has gotten used to and is good at breastfeeding. Lactation professionals recommend waiting until a baby is about 3-4 weeks old before offering artificial nipples of any kind (including pacifiers).

If I Give My Baby Formula, How Do I Start?

If you're using formula because you're not producing the amount of milk your baby needs, nurse first. Then, give any pumped milk you have and make up the difference with formula as needed.

If you're stopping a breastfeeding session or are weaning from breastfeeding altogether, begin to replace breastfeeding with bottle feeds. As you do this, pump to reduce uncomfortable engorgement. Engorgement is when your breasts overfill with milk and other fluids and get painful, swollen, warm, or hard. This can lead to problems with plugged ducts (when the ducts won’t drain well or at all) or a breast condition called mastitis.

When you reduce the number of nursing sessions, your milk supply will decrease. Your body will adapt to produce just enough milk to fit your new feeding schedule.

How Might a Diet With Formula Affect My Baby?

Starting your breastfed baby on formula can cause some change in the frequency, color, and consistency of your baby’s poop. Be sure to talk your doctor, though, if your baby has trouble pooping.

If your baby refuses formula alone, you can try mixing some of your pumped breast milk with it to help the baby get used to the new taste.

Is it OK for Me to Give My Baby the First Bottle?

If possible, have someone else give the first bottle. This is because babies can smell their mothers and they're used to receiving breast milk from mom, not a bottle. So try to have someone else — like a caregiver or partner — give the first bottle.

Also consider being out of the house or out of sight when your baby takes that first bottle, since your little one will wonder why you're not doing the feeding as usual. Depending on how your baby takes to the bottle, you might need to keep doing this until your baby gets used to bottle feeding.

If your baby has a hard time adjusting to this new form of feeding, be patient and keep trying. Talk to your doctor if you have questions.

Does My Breastfed Baby Need Supplements?

Breast milk contains many vitamins and minerals. But it’s a good idea to give a daily supplement for some nutrients that may be lacking. It all depends on your baby’s age. 

Here are some guidelines: 

• Vitamin D. Breastfed babies need to take a daily vitamin D supplement. Vitamin D is added to infant formulas. Vitamin D is made by the body when the skin is exposed to sunlight, but it is not safe for infants under 6 months to be in direct sunlight. (After 6 months, use sunscreen when in the sun to protect your baby’s sensitive skin).
• Iron.Iron is a mineral found in breastmilk during the first 4 months of life. After that, babies need an iron supplement until they begin eating enough iron-rich foods (such as cereals or meats) when they’re around 6 months old. If your baby gets a mix of breast milk and iron-fortified formula, talk to your doctor about whether your little one needs a supplement. After they start on solids, some babies still need iron supplements if they don’t eat enough iron-rich foods. You doctor can tell you if your baby is getting enough iron.
• Fluoride. Babies younger than 6 months do not need a fluoride supplement. After your baby is 6 months old, you can start supplementing with fluoride if your water supply lacks fluoride. Well water, bottled water, tap water in some communities, and ready-to-feed formulas do not have fluoride.
  
  It’s important to find out if your water supply has fluoride in it. You can ask your doctor, dentist, or local water utility agency if the water in your community is fluoridated. Giving a child too much fluoride can cause white marks on the teeth, so there is no need to give a fluoride supplement if your child gets enough fluoride from water.

When Should I Introduce Solid Foods?

The best time to introduce solid foods is when your baby has the skills needed to eat, usually between 4 and 6 months of age. This is when your baby:

• has good head and neck control
• can sit up
• has lost the tongue-thrust reflex (which causes babies to push food out of the mouth) 
• has the motor skills needed to transfer food to the back of the mouth to swallow
• shows an interest in food (by watching others eat, reaching for food, or opening the mouth as food approaches)

By this age, babies usually weigh twice their birth weight, or close to it.

Wait until your baby is at least 4 months old and shows these signs of readiness before starting solids. Many babies exclusively breastfeed until 6 months of age, which is perfectly healthy.

Babies who start solid foods before 4 months are at a higher risk for obesity and other problems later on. They also aren't coordinated enough to safely swallow solid foods and may choke on the food or inhale it into their lungs. 

How Should I Start Solids?

When the time is right, start with a single-grain, iron-fortified baby cereal. Rice cereal has traditionally been the first food for babies, but you can start with any you prefer. Start with 1 or 2 tablespoons of cereal mixed with breast milk, formula, or water. Never add cereal to a baby's bottle unless your doctor recommends it.

Another good first option is an iron-rich puréed meat. Feed your baby with a small baby spoon.

At this stage, solids should be fed after a nursing session, not before. That way, your baby fills up on breast milk, which should be your baby's main source of nutrition until age 1.

When your baby gets the hang of eating the first food, introduce others, such as puréed fruits, vegetables, beans, lentils, or yogurt. Wait a few days between introducing new foods to make sure your baby doesn't have an allergic reaction.

Experts recommend introducing common food allergens to babies when they're 4–6 months old. This includes babies with a family history of food allergies. In the past, they thought that babies should not get such foods (like eggs, peanuts, and fish) until after the first birthday. But recent studies suggest that waiting that long could make a baby more likely to develop food allergies.

Offer these foods to your baby as soon as your little one starts eating solids. Make sure they're served in forms that your baby can easily swallow. You can try a small amount of peanut butter mixed into fruit purée or yogurt, for example, or soft scrambled eggs.

When Can I Give My Baby Water?

In their first few months, babies usually don't need extra water. Breast milk and formula supply all the fluids that your baby needs. On very hot days, most babies do well with extra feedings.

When your baby starts eating solid foods, you can offer a few ounces of water between feedings, but don't force it.

What About Juice?

Fruit juices are not recommended for babies. Juice offers no health benefits, even to older children. Juice can fill them up (leaving little room for more nutritious foods), promote obesity, cause diarrhea, and even put a baby at risk for cavities when teeth start coming in.