Normal breast milk or formula usually has 20 calories per ounce. Most babies do well on regular breast milk or formula. Your baby may need high calorie breast milk or formula if she is smaller than normal or gains less weight than expected.

Do not give your baby high calorie milk or formula unless your healthcare provider tells you to do so. It may cause health problems if your baby can’t digest it properly.

High calorie milk may be 22 or 24 calories per ounce. It depends on how many calories your baby needs. You can make high calorie milk using formula or pumped breast milk.

Some formulas are made just for premature infants. These are called premature follow-up formulas. They have extra calories when you follow package directions. These formulas should not be used by babies who were full-term. You do not need to use a special premature formula to fix high-calorie breast milk for a premature baby. Regular formula works fine.

Measure carefully when making high-calorie formula. Use a special measuring spoon to make sure you get the right dose. The average household teaspoon may not hold the right amount.

**To make 22-calorie per ounce breast milk:**

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

**To make 24-calorie per ounce breast milk:**

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

**To make 22-calorie per ounce formula (starting from powder that normally makes 20-calorie per ounce):**

If you have the concentrated liquid formula, mix 5.5 ounces (163 mL) of formula with 4.5 ounces (133 mL) of water.

If you have the powder formula, mix 3 scoops of powder with 5.5 ounces (163 mL) of water.

**To make 24-calorie per ounce formula:**

If you have the concentrated liquid formula, mix 3 ounces (89 mL) of formula for 2 ounces (59 mL) of water.

If you have the powder formula, mix 3 scoops of powder with 5 ounces (148 mL) of water.

Your provider may suggest that you use a special premature follow-up formula. You can buy these products at the store.

To make 22-calorie per ounce formula:

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

**To make 24-calorie per ounce formula:**

Mix 2 scoops of premature follow-up formula with 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 1 hour or more. Throw away any refrigerated formula after 24 hours.

Call your healthcare provider if:

- You have questions about how to fix formula for your baby.
- Your baby is not growing even with the 24-calorie per ounce formula.

Written by Robert Brayden, MD, Clinical Professor of Pediatrics, University of Colorado School of Medicine.

Pediatric Advisor 2015.2 published by RelayHealth.

Last modified: 2014-10-23

Last reviewed: 2014-10-16

Last modified: 2014-10-23

Last reviewed: 2014-10-16

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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