Patient Information Service
Women and children’s business unit
Bottle feeding
your baby
This leaflet will give you information on how to sterilise feeding
equipment and how to prepare infant formula to minimise the
risks to your baby.
Feeding your baby in hospital
You will need to provide your own ‘ready-to-feed’ liquid infant
formula while you are in hospital.
It is recommended whilst you and your baby are in hospital that
you use the 250ml size cartons as any larger will probably go to
waste.
These can be bought at any local superstore or chemist and it is
important that you purchase ‘first milk’ (it is described further in
this leaflet why this is necessary)
The ready-to-feed infant formula is sterile which can help reduce
the risk of infections.
The hospital will provide teats and empty bottles so there is no
need to bring any in. This milk can be kept in the hospital fridge
for only 24 hours once opened and will be discarded by the staff
when this time is up.
Feeding your baby at home
You may be wondering why it is so important to be very careful
when making up bottle feeds for your baby. Unlike breastmilk,
formula milks can be given to a baby at the wrong temperature,
and if made up incorrectly could make your baby ill if it is made
up too strong or contaminated with germs.
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That is why we ask you and anyone else involved in preparing
your baby’s feeds to read this information very carefully. Family
and friends who have had children before may think they know
what they are doing but be sure they know the current and
most up-to date information to ensure your baby’s well being.
Be sure that before the baby is born to have all you need
to prepare bottle feeds, ready for when you get home from
hospital or following delivery if you have a home birth.
Your community midwife will visit you at home and is available
to give you help and information if needed. After the first ten
days your health visitor will visit you and will be available to
offer continuing advice on feeding your baby.
What is infant formula?
Infant formula is made from cow’s milk that has been treated
to make it suitable for babies. There are a number of different
brands in the shops that meet the required legal standards.
The cow’s milk in infant formula contains a mix of two types of
proteins – whey and casein.
Infant formula is available in two different forms:
• Ready-to-feed liquid, sold in cartons which is sterile
• Powdered infant formula, which is not sterile.
First infant formula
This is often described as suitable for newborns. It is based on
the whey of cow’s milk and is thought to be easier to digest than
other types of infant formula. This should always be the first
formula you give to your baby.
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Unless your midwife, health visitor or GP suggests otherwise,
this is the only infant formula your baby needs. Your baby can
stay on this formula when you start to introduce solid foods at
around six months, and continue on it throughout the first year.
When your baby is one year old, they can start to drink whole
cow’s milk.
There is no evidence to suggest that changing the brand
of infant formula your baby drinks does any good or harm.
However, if you think a particular brand of infant formula
disagrees with your baby, try another. Your midwife or health
visitor will be able to discuss this with you.
Milks which say they are ‘for hungrier babies’
These are not recommended for young babies; they are based
on the curd of cow’s milk and will take longer to digest than the
first milks.
Milks that say they are for babies over six
months (sometimes called ‘follow-on milks’
or ‘Toddler milks’)
Follow on milks should not be used for babies under six months
as they are not nutritionally stable
Research has found that there is no clear benefit from its use.
The labels can look similar to those of first milks, so read them
carefully.
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Goodnight milks (or milks which say they help
baby sleep)
These milks should never be given to a baby under the age of six
months as they are not nutritionally stable.
There is no independent evidence to support the claim that they
help babies settle or that they are easier to digest.
Soya formula
Soya infant formula is made from soya beans and not cow’s milk.
It contains high levels of a chemical called phytoestrogen
which may have a negative effect on babies and so should
only be used in exceptional circumstances and only under the
recommendation of a doctor.
Please note: Other specialised formulas may be prescribed by
doctors if a medical condition demands it.
Goat’s milk-based
Following changes to the regulations in February 2014, Goat’s
milk infant and follow-on formula is now permitted for sale in
the UK; however it is unlikely to be suitable for infants with a
cow’s milk protein allergy.
Ordinary cow’s milk
Cow’s milk should not be given as a main drink to infants under
one year, however small amounts of pasteurized whole cow’s
milk can be used when cooking and preparing food for your
baby when he/she is over six months of age.
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Types of milk to avoid
Not all milk is suitable for feeding babies. Here are some
examples of milk that SHOULD NOT be given to your baby
within the first year:
• Condensed milk
• Evaporated milk
• Dried milk
• Sheep’s milk
• Goat’s milk
• Cow’s milk as a drink
•Other types of drinks known as ‘milks’ such as rice, oat or
almond drinks.
Equipment
There is a large variety of feeding equipment available, you
will need a number of bottles (most newborn babies will need
six to eight feeds per day), teats, a bottle brush and sterilising
equipment. A simple easy-to-clean bottle is best.
Feeding teats can be made from rubber or silicone and vary in
shape. There is no evidence that one teat is better than another.
You can try different teats and use the one that suits your baby
best.
You can buy complete sets of bottles, sometimes with your
sterilising equipment. The cleaning and sterilising instructions
apply, whether you are using expressed breastmilk or infant
formula milk.
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There are several ways in which you can sterilise your baby’s
feeding equipment, such as:
• Cold water sterilising solution
• Steam sterilising
• Sterilising by boiling.
Before you sterilise
• Wash your hands first
•Wash all bottles, teats and equipment in warm soapy water.
Use a bottle brush to ensure that all milk solids are removed.
Never use salt to clean teats
• Rinse with fresh warm water.
Cold water sterilising solution
• Follow the manufacture’s instructions
• The solution must be changed every 24 hours
•All equipment and bottles must be completely immersed with
no air bubbles trapped inside – use the floating cover supplied
to ensure it is fully immersed
•Equipment needs to be left in the sterilising fluid for 30
minutes before use.
KEY FACT
All feeding items must be washed and rinsed before they are
sterilised. It is important to follow the instructions that come
with your steriliser.
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Steam sterilisation (electric or microwave)
• Follow the manufacturer’s instructions
•Make sure the openings of the bottles and teats are facing
down in the steriliser
•Manufacturers will give a guide as to how long you can leave
equipment that you are not using straight after sterilising
before it needs to be sterilised.
Never, use a microwave oven to heat babies’ bottles or any food
for babies or young children – dangerous hot-spots may form
and your child could be scalded.
Sterilising by boiling
Be careful to prevent anyone, especially children, from being
scalded or hurt if you are using the boiling method. Regularly
check that teats and bottles are not torn, cracked or damaged.
Remember: Teats tend to get damaged faster with this method.
• Hot pans and liquids should not be left attended
• Make sure that whatever you are sterilising is safe to boil
•Boil the equipment in water for at least ten minutes, making
sure that all items stay under the surface of the water
•Wash hands thoroughly, clean and disinfect work surfaces
where you will put the bottle and teat
•It is best to remove the bottles and teats just before they
are used
•If they are not being used immediately, they should be put
together so that the inside of the bottle and the inside and
outside of the teat are not contaminated.
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How to make up a feed
Bacteria in infant formula
Tins and packets of powdered infant formula can sometimes
contain bacteria such as Cronobacter sakazakii and sometimes
salmonella. Although these are rare these infections can be life
threatening.
To reduce any risk of infection, make up feeds one at a time
as your baby needs. It is no longer recommended to make
up a day’s feeds in the morning. Each bottle should be made
fresh using boiled water at 70 degrees or above – water at this
temperature will kill any harmful bacteria that may be present.
Bottled water is not recommended to make up a feed as it is not
sterile and may contain too much salt (sodium).
Bacteria multiply very fast at room temperature. Even when the
feed is kept in a fridge, bacteria can still survive and multiply,
although they do this more slowly. The risk of infection increases
over time so that is why it is important to make up the feed only
as your baby needs it.
Preparation and hygiene
A baby’s immune system is not as strong or as well developed as
an adult’s.
This means that babies are much more susceptible to illness and
infection.
Therefore good hygiene is very important when making up
a feed.
All equipment used to feed your baby must be sterilised.
Bottles, teats and any other feeding equipment need to be
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cleaned and sterilised before each feed to reduce the chance of
your baby getting sickness and diarrhoea.
It is best to use boiled drinking water from the tap to make up
a feed.
Do not use previously boiled water or artificially softened water.
KEY FACTS
•Always use boiled water at a temperature of at least 70°C, but
remember to let the feed cool before you give it to the baby
• Make up feeds, one at a time, as your baby needs them
•Never add extra powder to when making up a feed, this can
make your baby constipated and cause dehydration
•Always put the water in the bottle first, while it is still hot,
before adding the powdered infant formula
•Different tins of formula come with different scoops – only
use the scoop provided with the powder you are using
• Do not add sugar or cereals to the feed in the bottle
•Never warm up the infant formula in the microwave as it can
heat up the feed unevenly and may burn your baby’s mouth.
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Preparing feeds step-by-step
Step 1:
Fill the kettle with at least one litre of fresh tap water (do not
use water that has been boiled before, do not use artificially
softened water).
Step 2:
Boil the water, then leave to cool for no longer than 30 minutes
so that it remains at a temperature of at least 70°C degrees.
Step 3: Clean and disinfect the work surface you
are going to use.
Step 4:
It really is important that you
WASH YOUR HANDS thoroughly.
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Step 5:
If you are using a cold water
steriliser, shake off any excess
solution from the bottle and teat,
or rinse the bottle with the cooled
boiled water from the kettle,
not the tap (this would de-sterilise
the equipment).
Step 6:
Stand the bottle on a clean, level work surface.
Step 7:
Keep the teat and cap on the upturned
lid of the sterilizer. Avoid putting them
on the work surface as this is not sterile.
Step 8:
Follow the manufacturer’s instructions
and pour the required amount of water
into the bottle. Double check that the
water level is correct.
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Step 9:
Loosely fill the scoop with formula –
according to the manufacturer’s instructions.
Level it off using either the flat edge of a
clean knife or leveller provided.
Step 10: Add the correct number of scoops of
powdered formula to the water without
touching the sides of the bottle with the
scoop. Always use the scoop that is provided
with the tin.
Step 11:
Holding the edge of the teat put it on the
bottle. Then screw the retaining ring onto
the bottle.
Step 12:
Cover the teat with the cap and shake the
bottle until the powder has dissolved.
Step 13:
It is important to cool the formula so it is not too hot to drink.
Do this by holding the bottle under cold running water. Make
sure that the water does not touch the cap covering the teat.
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Step 14:
Test the temperature of the infant
formula on the inside of your wrist
before giving it to your baby.
It should be body temperature, which
means it should feel warm or cool,
but not hot.
Step 15:
If there is any made-up formula left after a feed throw it away.
Infant formula that has has been kept at room temperature
must be thrown away within two hours.
If you wish to give your baby your breastmilk via a bottle, and/or
optimise your breastmilk supply, please speak with your midwife
about this.
It is possible to return to breastfeeding your baby with the
right advice and support, please speak with your midwife.
Breastmilk is the healthiest form of nutrition for infants, and
exclusive breastfeeding is recommended for the first six months
of an infant’s life. After six months of age, breastfeeding
should continue for as long as the mother and baby wish, while
gradually introducing the baby to a more varied diet.
Feeding your baby
•Before feeding, wash your hands and try to ensure that you
and your baby are comfortable, and that you are not likely to
be disturbed
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•During the feed, hold your baby in your arms, close to you so
that you can maintain eye contact and talk or sing to him/her.
Never leave your baby unattended or prop the bottle up for
your baby to feed from because of the risk of choking
•Encourage baby to take the teat by moving it gently over his/
her top lip, never force the teat into baby’s mouth. Try to limit
who gives the feed, babies can feel insecure if they are fed by
lots of different people with different techniques
•Ensure that your baby is not lying flat and that the bottle is
held at an angle to prevent air from entering the teat
•Your baby is dependent on the person giving the feed,
therefore pace the feed by watching for the signs when your
baby may need a natural gap; don’t force him/her to finish
a feed, follow your baby’s appetite and accept when he/she
pushes the teat out with their tongue
•Some babies benefit from being winded during and after the
feed. To wind your baby hold him/her upright, keeping his/her
back as straight as possible, gently rub or pat your baby’s back
until the wind escapes. If you are unsure about winding, ask
your midwife to demonstrate it for you
•Skin to skin contact with your baby can help to comfort him/
her during and after a feed, speak with your midwife or
health visitor if you need more information.
Ready made carton feeds from the fridge should be allowed to
warm to room temperature before use. This can be speeded up
by standing the bottle in hand hot water or by using an electric
bottle warmer. Remember, never use a microwave to heat the
feed.
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He/she will let you know when hungry. Check with your midwife
or health visitor if you are not sure.
How often should bottlefed babies feed?
Newborn babies may take quite small volumes of milk to start
with, but by the end of the first week of life most babies will
take approximately 150 to 200ml per kg per day, although this
will vary from baby to baby.
Avoid overfeeding
Giving large quantities of milk in one feed will not necessarily
enable your baby to go longer between feeds, it is likely to
make him be sick or put on too much weight. Don’t try and
make him finish the bottle if he doesn’t seem to want it.
Baby-led feeding should be encouraged, if your baby is
regurgitating significant amounts this may mean that he wants
smaller amounts (but more often) than the ‘guide’ section on
the tin or packet suggests.
How do I know if my baby is hungry?
You will soon learn to recognise that your baby is ready to feed.
• Your baby will start to move about as they wake up
• Your baby will begin to move their head and mouth around
• Finally, they will find something to suck – usually their fingers.
Try to feed your baby before they cry as this is a late sign
of hunger.
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How can I tell that my baby is getting enough
milk?
Your baby’s weight gain and the number of wet and dirty
nappies will help to tell you if your baby is getting enough
formula.
Your baby should be producing around six wet nappies a day
a few days after the birth. These nappies should be soaked
through with clear or pale yellow urine.
For the first few days after birth your baby will pass dark sticky
stools (known as meconium). After the first week, however,
your baby should pass pale yellow or yellowish-brown stools.
Individual bowel habits vary, but as a general rule, bottlefed
babies will pass stools that are more solid, but less frequent,
than those of breastfed babies. You should contact your midwife
or health visitor if the number of stools per day changes or your
baby shows any signs of discomfort or straining while passing
stool.
Your baby will usually be weighed (naked) at birth and again at
five and ten days.
This weight should be filled in on the chart in your Personal
Child Health Record (the red book). If you have any questions or
concerns about your baby’s weight gain, speak to your midwife
or health visitor.
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After a feed
Throw away any milk that is not used within two hours of
warming. NEVER put left over milk back in the fridge to be
used later as this can give germs a chance to multiply. Clean and
rinse the bottles etc in cold water first and then prepare for
re-sterilisation.
Feeding when away from home
If you need to feed your baby away from home it is advised to
make up feeds as follows.
•Take a measured amount of infant formula in a clean
container
• Take a vacuum flask of hot water that has just been boiled
•Take an empty sterilised feeding bottle with cap and
retaining ring in place which can be removed when ready
to make a feed.
The water to make a feed must always be hot when you add the
formula powder otherwise bacteria in the infant formula may
not be destroyed.
The flask does not need to be sterilised but should be clean and
only used for your baby. If the flask is sealed and full, the water
should stay above 70 degrees for several hours.
You may prefer to use the ready-made infant formula when you
are away from home.
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If it is not possible to make up a fresh feed by following the
recommended advice, (for example to a nursery or child minder),
you should prepare the feed at home and cool it for at least an
hour in the back of the fridge.
It should then be taken out of the fridge before you leave and
carry it in a cool bag with an ice pack – and use it within four
hours.
Questions
Q When can I stop sterilising bottles and equipment?
AYou should sterilise all bottles and feeding equipment until
your baby is a year old.
Q Is there a formula that is closest to breastmilk?
ANo, It is impossible to replicate breastmilk and all formula
milks have to be of a similar composition to comply with EU
requirements.
Q When can I introduce cow’s milk?
AAs a drink, cow’s milk is best left until your baby is a year old
(1). However, after six months you may begin to use it for
mixing with food. Full fat cow’s milk should be used.
QMy baby keeps vomiting large amounts of milk, what should
I do?
AIf you baby repeatedly vomits large amounts, appears unwell
and/or has diarrhoea – call your GP immediately. Babies can
become ill very quickly so seek medical advice.
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Q I think my baby is constipated what should I do?
AOften this can be resolved with closer attention to the way in
which the feed is made up, or possibly by changing brands.
Ask your midwife or health visitor for advice.
QIs there any evidence that a ‘hungry baby’ formula will help
my baby sleep better?
ANo, there is no evidence that milks marketed for hungry
babies offer any advantage. It is recommended that first milks
are used throughout the first year of life if babies are not
being breastfed.
Q When should I start introducing solid foods?
AThe recommended time for introducing solid foods is when
your baby is approximately six months of age. Your health
visitor can advise you about when it is safe and appropriate to
introduce solid foods.
References
(1) Infant milks in the UK: A practical guide for health
professionals May 2014, www.firststepsnutrition.org/
newpages/Infants/infant_feeding.html
(2) UNICEF UK, Baby Friendly Initiative
(3) European Food Standards Agency, www.food.gov.uk
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Patient Information Service
If this leaflet does not answer all of your questions, or if you
have any other concerns please contact the infant feeding
advisor on: 01702 435555 ext 7296.
www.southend.nhs.uk
For a translated, large print or audio tape version
of this document please contact:
Patient Advice & Liaison Service (PALS)
Southend University Hospital NHS Foundation Trust
Prittlewell Chase
Westcliff-on-Sea
Essex, SS0 0RY
Telephone: 01702 385333
Fax: 01702 508530
Email: [email protected]
Written by Vicky Clark and the
infant feeding advisor
Reviewed and revised by Julie Newby,
infant feeding advisor, September 2014
Leaflet due for revision September 2016
Form No. SOU4069 Version 5