Making High-Calorie Formula or Breast Milk

Most babies are fine drinking regular breast milk or formula. Normal breast milk or formula usually has 20 calories per ounce. If your baby is smaller than normal or gaining less weight than expected, your healthcare provider may recommend that you make a higher calorie breast milk or formula for your child.

Your provider will usually recommend that you make milk that is either 22 or 24 calories per ounce, depending on how many calories your baby needs. You can make high calorie milk using formula or pumped breast milk.

There are some formulas made specially for children who were born prematurely. They are called premature follow-up formulas and already contain extra calories when prepared according to the package directions. They are made just for children who were born prematurely and should not be used by babies that were full-term.

Breast-Fed Babies (Full-Term and Premature)

  • To prepare a 22-calorie/ounce breast milk:

    Add 1/2 teaspoon of regular formula powder to every 3 ounces (89 mL) of pumped breast milk.

  • To prepare a 24-calorie/ounce breast milk:

    Add 1 teaspoon of regular formula powder to every 3 ounces (89 mL) of pumped breast milk.

When preparing high-calorie breast milk for premature babies you do not need to use special premature formula. Regular formula works fine.

Formula-Fed Full-Term Babies

  • To prepare a 22-calorie/ounce formula:

    If you are using concentrated liquid formula, mix 5.5 ounces (163 mL) of formula with every 4.5 ounces (133 mL) of water.

    If you are using powder formula, mix 3 scoops of powder with every 5.5 ounces (163 mL) of water.

  • To prepare a 24-calorie/ounce formula:

    If you are using concentrated liquid formula, mix 3 ounces (89 mL) of formula for every 2 ounces (59 mL) of water.

    If you are using powder formula, mix 3 scoops of powder with every 5 ounces (148 mL) of water.

Formula-Fed Premature Babies

If your baby was born prematurely, your provider may recommend using a special premature follow-up formula. You can buy these special follow-up formulas at the store. Examples include NeoSure Advance Premature Infant Formula and Enfacare Lipil Formula.

  • To prepare a 22-calorie/ounce formula:

    Mix 2 scoops of premature follow-up formula with every 4 ounces (118 mL) of water.

  • To prepare a 24-calorie/ounce formula:

    Mix 2 scoops of premature follow-up formula with every 3 1/2 ounces (104 mL) of water.

Do not add sugar, honey, or any other sweetener to the milk or formula. Never give honey to babies. Honey may cause a serious disease called botulism in children less than 1 year old. Discard bottles of formula left out of the refrigerator for one hour or more. Discard any refrigerated formula after 24 hours.

If you have questions about preparing formula for your baby, call your healthcare provider.

Written by Robert Brayden, MD, Associate Professor of Pediatrics, University of Colorado.
Published by RelayHealth.
Last modified: 2008-08-11
Last reviewed: 2008-11-06
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
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