The following sections contain information to support parents to bottle feed their babies in a safe and responsive way.
Most infant formula is made from cow’s milk that has been treated to make it suitable for babies. Cow’s-milk-based infant formula is the only infant formula your baby needs. You should not feed your baby other formulas unless your midwife, health visitor or GP recommends you to. If you think a particular brand of infant formula disagrees with your baby, ask your GP, midwife or health visitor for advice.
In the UK there are a variety of infant milks for sale. These are marketed as:
Hungrier baby milks and follow on milks are not recommended at any time only first milks should be given.
Not all milk is suitable for feeding babies. Here are some of the types you should not give to your baby under a year old.
Other full-fat dairy products such as yoghurt or fromage frais can be given after six months, once your baby is used to eating solid foods.
Even when tins and packets of powdered infant formula are sealed, they can sometimes contain bacteria such as Cronobacter sakazakii and, more rarely, salmonella. Although these bacteria are very rare, the infections they cause can be life-threatening.
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.
To reduce the risk of infection, it's best to make up feeds one at a time, as your baby needs them.
Use freshly boiled drinking water from the tap to make up a feed. Don't use artificially softened water or water that has been boiled before.
Leave the water to cool in the kettle for no more than 30 minutes. This will ensure it stays at a temperature of at least 70C. Water at this temperature will kill any harmful bacteria. Remember to let the feed cool a little more before you give it to your baby.
Bottled water is not recommended for making up feeds, as it's not sterile and may contain too much salt (sodium) or sulphate. If you have to use bottled water to make up a feed, check the label to make sure the sodium (also written as Na) level is less than 200 milligrams (mg) per litre, and the sulphate (also written as SO or SO4) content is not higher than 250mg per litre. It's not usually sterile so, like tap water, it will still need to be boiled before you prepare the feed.
Step 1 - Fill the kettle with at least 1 litre of fresh tap water (don't use water that has been boiled before).
Step 2 - Boil the water. Then leave the water to cool for no more than 30 minutes, so that it remains at a temperature of at least 70C.
Step 3 - Clean and disinfect the surface you are going to use.
Step 4 - It's very important that you wash your hands.
Step 5 - If you are using a cold-water steriliser, shake off any excess solution from the bottle and the teat, or rinse the bottle with cooled boiled water from the kettle (not tap water).
Step 6 - Stand the bottle on a clean surface.
Step 7 - Keep the teat and cap on the upturned lid of the steriliser. Avoid putting them on the work surface.
Step 8 - Follow the manufacturer's instructions and pour the amount of water you need into the bottle. Double check that the water level is correct. Always put the water in the bottle first, while it is still hot, before adding the powdered infant formula.
Step 9 - Loosely fill the scoop with formula, according to the manufacturers instructions, and level it off using either the flat edge of a clean, dry knife or the leveler provided. Different tins of formula come with different scoops. Make sure you only use the scoop that is enclosed with the powdered infant feeding formula you are using.
Step 10 - Holding the edge of the teat, put it on the bottle, then screw the retaining ring onto the bottle.
Step 11 - Cover the teat with the cap and shake the bottle until the powder is resolved.
Step 12 - It's important to cool the formula so it;s not too hot to drink. Do this by holding the bottom half of the bottle under cold running water. Make sure the water does not touch the cap covering the teat.
Step 13 - Test the temperature of the 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 14 - If there is any made-up formula left after a feed, throw it away
Never warm up infant formula in a microwave, as it can heat the feed unevenly and may burn your baby’s mouth.
Your baby is most vulnerable to diseases and illnesses during the first year of his life. If bottles are not sterilised then you risk having bacteria build up and potentially causing your baby to become ill. Fortunately sterilizing your baby’s bottles and nipples is dead simple. Read on to find out about all the different ways to keep your baby feeding equipment sanitized.
Before you sterilise, you’ll need to clean the used bottles thoroughly. Wash the bottles in clean soapy water, along with the teats, retaining rings, caps, and the manufacturer’s scoop that comes with the tin of formula. This way, every trace of milk is removed.
It's best to clean the equipment as soon as possible after a feed, before the milk has had a chance to dry on. Use clean, hot, soapy water and a clean bottle brush (NHS 2012a). Take extra care when washing the teats to make sure any stubborn milk curds come off, as these can survive the sterilising process.
To clean the teats fully, wash the inside of the teat by turning it inside-out. When you’ve washed everything, carefully rinse off all the detergent.
You can also use a dishwasher to wash your baby’s bottles, as long as the bottles are dishwasher safe. You may want to wash the teats separately, though, to be sure they're totally clean.
Check teats and bottles carefully and throw out any that are badly scratched, split, or cracked. Bacteria can stay in damaged surfaces and survive the cleaning and sterilising process (NHS 2012a).
There are several ways to sterilise your babies feeding equipment. Electric steam sterilising and microwave sterilising are the most popular. However, for times when you don’t have access to electricity, use traditional methods, such as cold-water sterilising.
Electric steam sterilisers are quick and efficient, taking eight minutes to 12 minutes, plus cooling time. They can keep bottles sterilised for up to six hours if you leave them in the steriliser with the lid closed. Many steam sterilisers can hold up to six bottles at a time, and have a rack for smaller items such as teats and dummies.
Make sure bottles, teats, and other equipment are placed with their openings face down. Then you can be sure that they are fully sterilised. Check that you only put in equipment that is safe to steam. Some parts of breast pumps may not be suitable.
Many baby bottles can be sterilised in the microwave on their own. This is a quick and easy way to sterilise individual bottles - it takes just 90 seconds. If you use this method, remember to leave the bottles unsealed so that pressure cannot build up inside the bottle.
You can also buy steamers for microwaves, but you won't be able to put anything metal inside them. These steamers take about three minutes to eight minutes to work plus cooling time, depending on the model and your microwave wattage.
These sterilisers' main advantage is that there is no smell or taste left afterwards. The items also remain sterile for three hours if you keep the steriliser lid closed (FSA/NHS 2012). Take care when removing the lid of microwave steam sterilisers, as the inside can become very hot.
To sterilise your baby’s bottle-feeding equipment with cold water, use a sterilising solution dissolved in cold water. Some solutions also come in tablet form. The solution kills bacteria very effectively. You’ll need to change the solution every 24 hours.
You can buy special sterilising units for cold-water sterilising. Or you can use a clean bucket or plastic container with a lid. However, if you are not using a special unit, try not to reuse the same plastic container for sterilising. It is also not a good idea to use an ice cream tub. Sometimes the sterilising solution can affect the plastic and contaminate the solution.
If you use a bucket or container, use something weighty, such as a heavy plate, to keep the bottles and other equipment completely under the solution. You need to check that there are no air bubbles left in the bottles, and keep everything submerged for at least 30 minutes to sterilise it all (FSA/NHS 2012).
Also, always follow the manufacturer's instructions as to how much water and sterilising solution to use. If your solution is too concentrated or too dilute, it could affect how well your baby's feeding equipment is sterilised.
Take out bottles and teats only when you need to use them. Give each item a shake as you take it out, and rinse off the fluid with cool, boiled water (Crawley and Westland 2013).
Continue to sterilise your baby’s bottle feeding equipment for at least his first year (NHSinform 2011). You may think sterilising is rather pointless when your baby is putting all sorts of things in his mouth. However, your baby's immune system is still developing and it's easy for him to pick up infections during his first year. The bugs that stick to milk curds in partially cleaned bottles can be particularly nasty.
By the time your baby is one year old he'll have started to produce his own antibodies and be more resistant to harmful germs. However, it's a good idea to carry on sterilising bottles, Dummies, and teats until your baby stops using them.
NHS Choices - Sterilising Bottles
Unlike breastfeeding, we’ve all seen bottle feeding, and we all know how to do it. We’ve been surrounded by it growing up. If someone handed you a baby and a bottle you would know what to do right? Of course you would, but would you know how to do it without causing stressful feeding? Despite the large number of parents who use bottles in today’s society (whether those bottles contain breast milk or formula), there are very few who have actually been taught how to bottle feed their baby in a manner that is respectful of the baby’s airway and natural feeding rhythm.
Feeding your baby is about so much more than just food, it’s about bonding, emotional and physical comfort and connection. These benefits however are not just reserved for breastfeeding. Did you know that it is perfectly possible to bottle feed your baby in a natural, nurturing baby led way?
UNICEF makes the following recommendations about how to encourage responsiveness and discourage overfeeding when bottle-feeding:
Wait until your baby is hungry (see above)
Use your baby’s behaviour as a guide for feeding rather than the clock. On average, most bottle fed babies like to feed around three – four hourly but this is a guide not a prescription.
Remember like us, a baby’s hunger can vary. Some days they are hungrier than others
The volume amounts for age on formula tins are a guide. Every baby is an individual and how much they need and want to drink will be different.
Remember you cannot control whether your baby sucks or how much they drink. Healthy babies know if they are hungry and when they are full. Feeding is not about parents controlling their baby’s milk intake.
Sucking can be hard work especially for young babies. It’s fine if they need to have a rest from sucking.
Make sure the teat flow is at a comfortable rate. Teat sizes and hole sizes are a guide only. Some babies have a very strong suck and feed quickly, others like to take their time.
If your baby is pulling away from the teat, crying, closing their lips together and spitting out milk they are telling you they don’t want to feed anymore.
Allow some time and opportunity for burping. Half way through the feed and at the end suits most babies.
Bottle feeding is different to breastfeeding. If your baby is changing from breast to bottle feeding then expect some transition time as they develop different sucking and feeding skills.
Think about the feeding experience from your baby’s perspective. Do you think they are comfortable, relaxed, happy and content? Putting yourself in your baby’s “skin” is truly empathetic.
Try not to feed your baby for too long. If your baby hasn’t finished their bottle within 45 minutes or so then stop and offer another bottle in a few hours.
Often formula feeding is linked heavily with feeding to a schedule. This really doesn't have to be the case though as it is easy to responsively feed. Responsive feeding is all about being aware of your baby's hunger cues.
Breastfeeding gives wonderful skin to skin contact which is a brilliant baby calmer, however there is no reason why you cannot do this when bottle feeding. Undo some buttons on your shirt, or lift your shirt up and hold your baby close to your chest with their face on your bare skin. This isn’t just for mums, partners can do this too.
There are many well-documented benefits of skin-to-skin contact between a new-born infant and its mother. Skin-to-skin contact improves physiologic stability for both mother and baby in the vulnerable period immediately after birth, increases maternal attachment behaviour’s, protects against the negative effects of maternal–infant separation and supports optimal infant brain development.
Offer the bottle rather than just sticking it in their mouth. When they open wide, ease the teat in.
Hold your child reasonably upright and the bottle kind of parallel to the floor (this becomes impossible when you get down to the last couple of ounces – that’s when we just end up tipping it). Allow air intake but make sure to wind properly afterwards. This means that they regulate how much they take from the bottle rather than sucking and swallowing simply because of constant flow.
Every now and then tip the teat upwards but keep it in her mouth. This mimics the let-down and pause of breastfeeding.
It’s surprisingly tempting while feeding to just zone out and watch TV or whatever. Let’s face it, it’s not the most riveting task in the world when you’re doing it at least six times a day. But when we’re bottle feeding, we feel it’s even more important to try reclaim the intimacy we could be losing. So be careful to hold them close and look into your child's eyes. Every now and then get topless, strip them down to their nappy and have a skin-to-skin bottle feed.
Encouraging a close mother-baby relationship is important in the early days following birth. When mothers and babies breastfeed they spend a great deal of time in close contact which helps build and enhance their relationship. Encouraging formula feeding mothers to give most feeds themselves while holding their baby close will support relationship building.
All babies cry, and some cry a lot. Crying is your baby’s way of telling you they need comfort and care.
Sometimes it’s easy to work out what they want, and sometimes it isn’t. The most common reasons for crying are:
There may be times of the day when your baby tends to cry a lot and can’t be comforted. Early evening is the most common time for this to happen. This can be hard for you as it’s often the time when you’re most tired and least able to cope.
See why you should never shake a baby.
Try some of the following ways to comfort your baby. Some may be more effective than others:
Ask your pharmacist for advice
Some babies cry and seem unsettled around the time of a feed. If you’re breastfeeding, you may find that improving your baby’s attachment helps them settle. You can go to a breastfeeding or drop-in centre and ask for help, or talk to your health visitor.
It may be that something you’re eating or drinking is affecting your baby. Some things will reach your milk within a few hours, while others may take 24 hours. All babies are different, and what affects one won’t necessarily affect yours. You might want to consider avoiding dairy products, chocolate, fruit squashes, diet drinks and drinks containing caffeine.
If this doesn’t work, try keeping a note of when the crying happens to see if there’s a pattern. Sometimes, crying during feeds can be a symptom of reflux, a common condition in which babies bring back milk after feeds. Speak to your GP or health visitor for more information and advice.
Colic is the medical term for excessive, frequent crying in a baby who appears to be otherwise healthy and well fed. It is a common yet poorly understood condition, affecting up to one in five babies.
Colic usually begins within the first few weeks of life but often stops by the time the baby is four months old, and by six months at the latest.
In most cases, the intense crying occurs in the late afternoon or evening and usually lasts for several hours. You may also notice that your baby's face becomes flushed, and they may clench their fists, draw their knees up to their tummy, or arch their back.
If your baby has colic, they may appear to be in distress. However, the crying outbursts are not harmful and your baby will continue to feed and gain weight normally. There is no clear evidence that colic has any long-term effects on a baby’s health.
Babies often bring up milk during or shortly after feeding – this is known as 'possetting', or 'reflux'.
This is different to vomiting, where the baby's muscles forcefully contract (vomiting in babies is covered separately). Reflux is just your baby passively "spitting up" whatever they have just swallowed.
However, it can still be upsetting to parents, and it's natural to be worried that something is wrong.
It's important know that reflux is normal, and often just the result of a baby's underdeveloped oesophagus (food canal).
It usually stops when the baby reaches 12-14 months of age, when the ring of muscle at the bottom of their oesophagus fully develops and closes off, preventing stomach contents from leaking out. It's unusual if reflux continues at 18 months.
Only in a small number of cases can reflux be a sign of a more serious problem, such as gastro-oesophageal reflux disease (GORD), a milk allergy or a blockage.
What tips can I try to help my baby's reflux?
What might the problem be, in this case?
