Bottle feeding - nutrition and safety

Breastmilk or a suitable infant formula is recommended as the main source of nutrition for all babies under 12 months of age. Breastmilk is the feeding option of choice, but commercial infant formula is the only suitable alternative when breastmilk is not available. Homemade, do-it-yourself formula recipes should not be used.

Commercial infant formulas are designed to provide nutrition similar to breastmilk. They supply everything your baby needs until you introduce solids at around 6 months. Infant formula is made to meet recognised food safety standards, and there is little difference between differently priced brands.

Types of formula#

The composition of infant formula continues to change as research improves our understanding of the unique ingredients in breastmilk. A range of new ingredients has been added to formulas in recent years.

There is a variety of starter formulas based on cow’s milk protein (whey or casein). Formula based on soy or goat’s milk is also available. These formulas are suitable for babies from birth to 12 months.

Read the label carefully. Formulas for toddlers, and even products for pregnant women, can look very similar to infant formula, so check that your baby gets a formula that is safe and appropriate for their age. The label may list additions such as LCPUFAs (long-chain polyunsaturated fatty acids, or omega-3 fatty acids), probiotics or prebiotics. These ingredients are added because they are found naturally in breastmilk.

Changing formula#

If your baby sleeps or feeds poorly, or is unsettled or “colicky”, you may feel you need to change formula. There is little evidence that this helps most babies. Seek the advice of your child health nurse or doctor before switching formulas.

Soy formula#

Infant soy formula is suitable for babies who have a medical reason to use it, such as an allergy to cow’s milk. It must not be confused with regular soy milk, which does not provide suitable nutrition for babies.

“Follow on” formula#

“Follow on” formula is suitable for babies aged 6 months and over, and it is your choice whether you use it. It is available based on cow’s milk, soy or goat’s milk, and contains higher protein and mineral content than starter formula.

Specialized infant formula#

Infant formula can be modified in various ways, including changes to fat, carbohydrate or protein content. Specialized formula is sometimes needed for babies with certain medical conditions and may be prescribed by a pediatrician. Reasons for using one include severe allergy, malabsorption, digestive disorders or metabolic conditions. Examples include:

• Low lactose – used for lactose (milk sugar) intolerance.
• Modified protein content – in some formulas the cow’s milk protein is broken into smaller units; in others the whole protein is replaced by amino acids, the individual building blocks of protein. These are used for severe allergy, malabsorption, digestive disorders or metabolic conditions.
• Modified fat content – includes formula with a high concentration of triglycerides and lower levels of fatty acids, which may be used for babies with liver or gastrointestinal conditions.
• Thickened formula – sometimes recommended for babies who frequently regurgitate large amounts after feeding, although it may not solve the problem. Only use under medical advice.
• Premature infant formula – designed for preterm babies, who need extra energy and minerals. It is not suitable for full-term babies, or for preterm babies who are now full term, unless advised by a doctor.

Always seek medical advice before using a specialized formula.

How much formula your baby needs#

• From 5 days to 3 months, a full-term, healthy baby needs about 150 mL of prepared formula per kilogram of body weight each day. For example, a baby weighing 3 kg needs about 450 mL each day.
• From 3 to 6 months, this falls to about 120 mL per kilogram of body weight each day.
• From 6 to 12 months, it falls again to between 90 and 120 mL per kilogram of body weight each day.

Premature babies need more. At first they usually need about 160 to 180 mL of formula per kilogram of body weight per day. Your neonatal doctor or child health nurse will advise you. See your doctor or child health nurse if you are worried about your baby’s appetite or growth.

Preparing formula safely#

Always remember to:

• Wash your hands thoroughly and make sure your preparation area is clean.
• Check the date on the bottom of the tin or on the sachet to ensure the formula has not passed its use-by date. Use the powder within one month of opening the tin.
• Follow the manufacturer’s instructions strictly. Accuracy is important so your baby receives the right nutrition.

To make up a bottle:

• Boil fresh, clean water in a kettle or saucepan. Do not let the water cool for longer than 30 minutes before making up the formula. Hot water helps kill any bacteria (germs) in the powder.
• Pour the recommended amount of boiled water into the bottle.
• Use the scoop that came with the formula to measure the exact amount of powder. A scoop from another brand might be larger or smaller. Never use a half-scoop, as it may not be accurate, and make up the full volume (you can throw out any leftover later).
• Level the powder with a sterilized knife or spatula (do not pack it down), then add it to the bottle of boiled water.
• Place the disc and cap on the bottle and shake until thoroughly mixed.

Make up only one bottle at a time, because germs can easily grow in prepared formula and make your baby ill.

Warming a bottle#

Do not warm a bottle in a microwave oven. This is unsafe because it does not heat evenly, and “hot spots” in the bottle can burn your baby’s mouth.

You can warm a bottle by standing it in a container of hot (not boiling) water for 10 minutes. Test the temperature by dripping some milk onto the inside of your wrist; it should feel about the same as your skin. If it is too warm, cool the bottle under running water or in a container of cool water, then re-test on your wrist before giving it to your baby.

If you are going out for the day, carry hot water in a flask and the formula separately, then prepare the bottle just before it is needed.

When a tin of formula is empty, discard the scoop that came with it. If you change brands, read the instructions carefully to ensure you use the correct amount of water and powder.

Do not use leftover formula#

Use a fresh bottle for every feed. Throw away any leftover formula or expressed breastmilk after a feed. Never give your baby leftovers, as they can grow bacteria that may make your baby ill. Do not add other food, such as baby rice cereal, to the milk. If you think your baby needs more food than recommended, talk to your child health nurse.

Enjoy mealtimes with your baby#

Mealtimes are a chance to be together and communicate. Just as adults and children enjoy talking at mealtimes, so do babies. Hold your baby close to your body, facing you, when feeding, so it is an enjoyable and social experience for you both.

Take the bottle away as soon as your baby has had enough. Do not put your baby to bed with a bottle to feed alone. This is dangerous because your baby may choke. Older children who are regularly fed this way are also more likely to get middle-ear infections and tooth decay.

Equipment for bottle-feeding#

Whether you are using a bottle for expressed breastmilk or infant formula, you will need:

• At least 3 large bottles with leak-proof caps, discs and teats.
• Clean water.
• Sterilizing equipment (and possibly sterilizing chemicals).

Bottles#

Plastic bottles are better, because glass breaks more easily. Bottles should be smooth on the inside (no ribbing or indentation) so they are easy to clean properly, and should have clearly marked measurement guides that will not wear off over time.

Teats#

When choosing teats, consider:

• Flow rate – check the label to make sure the teat has the right flow rate for your baby’s age. A teat designed for an older baby can flood a newborn’s mouth with too much milk and may lead to choking.
• Testing the flow – hold the bottle upside down; milk should drip out at a constant, steady rate. If it drips too slowly, your baby will tire before finishing. If it pours out in a stream, your baby may dribble and splutter and will not enjoy the feed. A baby should take 15 to 30 minutes to drink a bottle.
• Teat shape – many manufacturers claim their teats copy a mother’s nipple, but there is no proof that any design is best. “Orthodontic” teats are no better than regular-shaped teats and may not be good for later tooth development. Over time you will discover which teat works best for your baby.
• Air – air bubbles should rise through the milk as the baby drinks. If the teat flattens during feeding, loosen the cap a little.

Sterilizing bottle-feeding equipment#

You must sterilize (thoroughly clean and kill all germs) all bottle-feeding equipment until your baby is 12 months old. This is very important.

Always remember:

• Steam can cause severe skin burns, so be careful when boiling or steaming equipment.
• Place all equipment out of reach of children.
• Avoid unnecessary handling of sterilized equipment, and do not touch the inner surfaces of bottles or teats.

First, wash all the equipment in warm, soapy water. Use a clean bottle brush to remove all traces of milk, then rinse, then sterilize. You can use different methods, such as boiling, chemicals, steam or microwave steam.

Boiling#

• Put all equipment in a large pot and cover with clean water, making sure no air bubbles are trapped inside the bottles.
• Put the lid on and bring to the boil. Allow 5 minutes of rapid boiling, then turn off the heat and allow to cool.
• Always wash your hands thoroughly with soap and water before handling the equipment.
• Store the sterilized equipment in a clean container in the fridge, and re-boil after 24 hours if it has not been used by then.

Chemical sterilizing#

Sterilizing chemicals usually come in liquid or tablet form. To use them:

• Follow the manufacturer’s instructions to get the correct strength. Mix the chemicals with water in a large plastic or glass bowl.
• Place all equipment in the solution and cover every surface; for example, squirt solution through the teats and get rid of any air bubbles. Soak for at least one hour.
• Use only glass or plastic equipment, as metal will rust in the solution.
• Remove the equipment and shake off excess solution, but do not rinse.
• Change the solution every 24 hours. Scrub the container with warm soapy water and rinse thoroughly before refilling.

Steam sterilizing#

A steam sterilizer plugs into a power outlet and works automatically once switched on. Follow the manufacturer’s directions. Most will tell you to:

• Place the equipment in the sterilizer and add the correct amount of water.
• Put the lid on and steam for the recommended time.
• Leave the lid on until the bottles are needed.
• Wipe and dry the inside of the container once a day to keep it clean.

Microwave steam sterilizing#

This type is used in a microwave oven. You should follow the instructions carefully and check the microwave power needed, as not all microwave ovens are the same. Do not put any metal inside these sterilizers.

Milks to avoid under 12 months#

Babies under 12 months should not be given:

• Regular, low-fat or skim cow’s milk.
• Evaporated or powdered milk, or sweetened condensed milk.
• Cereal and legume-based beverages (such as rice, oat or soy drinks).
• Nut and seed-based beverages (such as almond or pumpkin seed drinks).

Key points#

• Some ingredients are added to formula because they are found naturally in breastmilk.
• Accuracy when preparing formula is important so your baby receives the right nutrition.
• Putting a baby to bed with a bottle to feed alone is dangerous because your baby may choke.
• Plastic bottles are better than glass, because glass breaks more easily.
• Steam can cause severe skin burns, so be careful when boiling or steaming equipment.

Where to get help#