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Daily Dose

Transitioning to Whole Milk or Toddler Formula

Is it best to transition to whole milk or use toddler formula instead?I received a question from our iPhone App regarding the use of a toddler formula, such as Enfagrow. The mother wondered if this was preferred over switching to cow’s milk when a child reaches 12 months of age.

While there have been several products that have been brought to market in the last few years, so called toddler’s formulas, there is really no evidence to show that these are preferable to using cow’s milk you’re your child reaches 1 year of age. The toddler’s formula does contain more calcium and phosphorous than infant formulas, but beyond that there is really no advantage to using a toddler formula over milk.  It really seems to be an expensive marketing ploy directed to parents who are concerned about calories and vitamins. The American Academy of Pediatrics recommends that 1 year old children either continue breast feeding or make the transition to whole milk.  It is also recommended that child transitions from bottle to a cup (sippy cup is fine). At that time a toddler should reduce their milk intake to approximately 16 ounces a day, as they are getting the majority of their nutrition from eating a wide variety of solid foods, with less calories coming from breast milk or whole milk.  If a parent is offering their toddler a variety of healthy foods, you will be amazed at what they will and will not eat, but they do manage to gain weight and grow, which often surprises their parents. The most interesting thing about a toddler, is that they self-regulate, and unlike adults, they eat when they are hungry, rather than out of boredom or due to stress.  So, if you offer your toddler healthy meals and snacks accompanied by whole milk from a cup, they will meet their nutritional requirements and also get enough calcium and vitamin D. On the other hand, for parents that have a difficult time dealing with a child’s whims for eating, and will indulge their child’s  food preferences,while also allowing them to have juice instead of milk, the idea of a toddler formula seems to be just the ticket! Just let them drink their nutrition (somewhat like an adult who might need a nutritional supplement like Ensure while they are sick), but this may not be the answer as this really just reinforces poor eating habits. Like many things in parenting, the “perceived” easy solution, may not always be the best. So, at the end of the day there is little need for “follow up  formulas” for the otherwise healthy toddler.  Save the money, buy whole cow’s milk unless otherwise directed by your pediatrician.  Make sure that your child is getting about 16–18 ounces of milk a day and several other servings of dairy products.  If you are really concerned about calcium and vitamin D as well as other vitamins, then offer them an over the counter vitamin supplement. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue.

Daily Dose

The Right Water For Formula?

A new parent asked me the other day if they could use concentrated or powdered your-baby formula that needed to be mixed with water.A new parent asked me the other day if they could use concentrated or powdered baby formula that needed to be mixed with water. That brought to mind the need to discuss fluoride and its importance in developing teeth.

Over the past 40 years, tooth decay in young children had been decreasing. Recent studies show that the trend is reversing and we are once again dealing with tooth decay in young children’s teeth. I had written in a previous column about “early childhood caries” as it related to prolonged bottle use, but early cavities may also be related to inadequate fluoride consumption. Fluoride is a natural mineral that protects and strengthens teeth from developing cavities. Infants’ teeth are developing and will be stronger and more resistant to cavities if they have been exposed to fluoride. Fluoride is found in drinking water we usually get from drinking water from the faucet in our homes. If the community water supply has greater than 0.6 ppm (you can check on this by checking with public health officials in your city) and you use tap water routinely then your infants and children are getting adequate fluoride and will not need supplements. The issue is that many families are drinking bottled water or use home filtration systems. In this case your infant may not receive the fluoride that they need. We don’t often think about fluoride and drinking water, but I am amazed at how many families are concerned about using tap water. We pay a water bill each month to provide water to our homes, one of the advantages of the modern age. This water is tested, protected and ensured to be safe, and on top of that has fluoride added at the correct amounts to ensure proper dental protection. So why do so many of us buy bottled water? At the same time it has been pointed out that plastic water bottles are filling up landfills, and polluting our environment. Who would have thought to invest in water that comes in bottles, not me. Sounds crazy. Why buy special “nursery water” which is costly and not eco friendly? So, why do we parents try to complicate things that don’t need to be complicated? Be thrifty and use the water you pay for out of the faucet. It is safer to mix formula with tap water, which provides adequate fluoride for those developing teeth, than using fluoride drops or supplements that may be forgotten or mis-measured. Along with protecting new teeth you will be protecting the environment, a “two-fer” for your baby. I am also going to practice what I preach and have stopped buying bottled water. I am now using a re-usable bottle for my daily workouts, filled with good old-fashioned tap water! That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Your Baby

Formula-Fed Babies: How Much and How Often?


There are many reasons a mother may choose to use formula instead of breast milk when feeding her newborn. There are also times when mothers decide to switch from nursing to formula, as their baby gets a little older.  Whether you’re breastfeeding or giving formula, it’s generally recommended that babies be fed when they seem hungry.

What kind of schedule and how much formula do formula-fed babies need? It all depends on the baby. While each infant’s appetite and needs may be a little different – there are general rules of thumb that can be helpful for moms to know.

According to, after the first few days, your formula-fed newborn will take from 2 to 3 ounces (60–90 ml) of formula per feeding and will eat every three to four hours on average during his or her first few weeks.

Occasionally, you may have a sleeper who seems to like visiting dreamland longer than most babies. If during the first month your baby sleeps longer than four or five hours, wake him or her up and offer a bottle.

By the end of his or her first month, they’ll usually be up to at least 4 ounces (120 ml) per feeding, with a fairly predictable schedule of feedings about every four hours.

By six months, your baby will typically consume 6 to 8 ounces (180–240 ml) at each of four or five feedings in twenty-four hours.

Since babies can’t communicate with words, parents have to learn how to read the signs and signals baby uses to express wants.

How do you know your baby is hungry? Here are signs baby may be ready to eat:

•       Moving their heads from side to side

•       Opening their mouths

•       Sticking out their tongues

•       Placing their hands, fingers, and fists to their mouths

•       Puckering their lips as if to suck

•       Nuzzling against their mothers' breasts

•       Showing the rooting reflex (when a baby moves its mouth in the direction of something that's stroking or touching its cheek)

•       Crying

The crying signal can be confusing for parents. It doesn’t always mean the same thing. Crying is also a last resort when baby is hungry. Your baby should be fed before he or she gets so hungry that they get upset and cry. That’s why guidelines are helpful when starting out.

Most babies are satisfied with 3 to 4 ounces (90–120 ml) per feeding during the first month and increase that amount by 1 ounce (30 ml) per month until they reach a maximum of about 7 to 8 ounces (210–240 ml). If your baby consistently seems to want more or less than this, discuss it with your pediatrician. Your baby should drink no more than 32 ounces (960 ml) of formula in 24 hours. Some babies have higher needs for sucking and may just want to suck on a pacifier after feeding.

Eventually, baby will develop a time schedule of his or her own. As you become more familiar with your baby’s signals and sleep patterns, you’ll be able to design a feeding schedule tailored to your infant’s needs.

Between two and four months of age (or when the baby weighs more than 12 pounds [5.4 kg]), most formula-fed babies no longer need a middle-of-the night feeding, because they’re consuming more during the day and their sleeping patterns have become more regular (although this varies considerably from baby to baby). Their stomach capacity has increased, too, which means they may go longer between daytime feedings—occasionally up to four or five hours at a time. If your baby still seems to feed very frequently or consume larger amounts, try distracting him with play or with a pacifier. Sometimes patterns of obesity begin during infancy, so it is important not to overfeed your baby.

The most important thing to remember is that there is no “one schedule and formula amount fits all” when it comes to babies and their needs.

No one can tell you exactly how often or how much your baby boy or girl needs to be fed, but good communication with your pediatrician and learning how to read your baby’s body language will go a long way in keeping baby’s feedings on track.

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