A can on infant formula is shown next to two baby bottles.
Experts warn parents of the dangers of inexact mixing of infant formula. (For Spectrum Health Beat)

Mixing infant formula can become so routine, it’s easy to lose sight of what a baby bottle contains.

But that formula, designed to meet an infant’s nutritional needs, should never be taken lightly, say pediatric experts with Spectrum Health Helen DeVos Children’s Hospital.

“You have to be precise in mixing the formula,” says Lana Gagin, MD, the medical director of the hospital’s Well Baby Unit. “If you mix formula incorrectly―if you water it down or make it too concentrated―it disturbs the electrolyte balance, which may lead to serious neurological consequences.”

The wrong balance of formula and water can cause nutritional deficiencies or dehydration. In the most severe cases, it can lead to a stroke, seizure, coma or even death for an infant.

Ask questions. Don’t be afraid to speak up about anything when it comes to your baby.

Dr. Daniel Fain
Pediatric neurologist

Getting nutrition right, day in and day out, is crucial for rapidly growing babies, says Daniel Fain, MD, a pediatric neurologist.

“Babies’ nervous systems are developing at an astounding rate,” he says. “If they are iron-deficient, or deficient in trace minerals, or especially deficient in protein or fats, that’s going to lead to nutritional problems.”

In the first two years of life, for example, a child develops most of the myelination of the neurons in the brain.

Myelin, a fatty coating on the axon of each neuron, “is crucial for proper information transmission and storage in the brain,” Dr. Fain says. “It’s important for memory, for fast reactions, for processing information and acting on it in the environment. It’s just vital.”

Follow directions

The use of infant formula affects families across the country. Although 79 percent of newborns in the U.S. breastfeed, only 49 percent still breastfeed at 6 months, according to the Centers for Disease Control and Prevention.

Pediatricians do not advise giving cow’s milk to children until they are at least 1 year old. So, a lot of babies rely on infant formula for their nutritional needs.

“Unfortunately, mistakes happen―not very often, but they do happen,” Dr. Gagin says.

First-time parents, overwhelmed with advice, education and the demands of caring for a newborn, are especially vulnerable, she says. She encourages parents to reach out to their doctors for additional support or to alert them if they suspect any problems.

Dr. Gagin offers the following tips in preparing formula:

  • Be sure to check the directions on the can. Most have the same powder-water ratio―one scoop to 2 ounces―but parents should make sure they know the correct mix.
  • Use the scoop that comes with the can. Other scoops might be slightly different.
  • When measuring the powder, scoop it up and use a clean knife to scrape away excess powder. Don’t pack the formula into the scoop.
  • Add the powder to the water and mix well.
  • Never water down formula.
  • If you have any questions about how to mix formula, ask your child’s pediatrician or primary care provider.

Standard infant formula delivers 20 calories per ounce.

“That is close to the calorie load in breast milk,” Dr. Gagin says. “This is what a healthy term baby needs.”

In some cases, with babies who are premature or have special needs, a pediatrician might recommend a slightly different mix of formula―one that would deliver 22 or 24 calories per ounce.

Parents with any questions or concerns should not hesitate to go over the directions carefully with their physician, she says.

Early signs of problems

The physicians also advised parents to be alert to signs of nutritional problems in their babies.

“If a child has a nutritional issue or is dehydrated, they are going to be lethargic, typically,” Dr. Fain says. “Excessive sleeping, inactivity, regression of development―those would be the big concerns.”

If a baby’s fontanelle―the soft spot on the skull―looks sunken, that also can be a sign of problems.

Often, a decrease in wet diapers can be a first sign of dehydration.

If parents struggle to afford infant formula, Dr. Fain encourages them to seek help. WIC, the federal Special Supplemental Nutrition Program for Women, Infants and Children, may provide assistance.

Dr. Gagin also urges parents to get medical advice if they see signs of problems―or even if a caregiver accidentally mixed the formula wrong.

“Parents need to be proactive,” she says, urging caregivers to call their pediatrician or specialist any time, day or night, if there is a concern. “We would much rather hear from our patients if they are ever in doubt.”

“I want parents to know they are not alone,” Dr. Fain adds. “There is help. If they are struggling to provide nutrition or if they have questions, they can reach out to their providers.

“Ask questions. Don’t be afraid to speak up about anything when it comes to your baby.”