Bottle Feeding

 

There are a few important guidelines to remember when feeding your baby using bottles, using expressed breast milk or infant formula.

Buying your feeding equipment

You will need a number of bottles and teats, as well as sterilising equipment. There is no evidence that one type of teat or bottle is better than any other. All feeding bottles are made of food-grade plastic, but some have shapes or patterns that make them difficult to clean thoroughly. A simple, easy-to-clean bottle is probably best.

Sterilise and safety check

Make sure your bottles and teats are sterilised. If you’re using infant formula, pay close attention to the instructions on the packet when you make up the feed.

Be prepared

Get everything you need ready before you start feeding. Find a comfortable position to hold your baby while you're feeding. You may need to give your baby time. Some babies take some milk, pause for a nap, then wake up for more. Remember, feeding is a chance to feel close to your baby and get to know them.

Keep the teat full

When feeding, keep the teat full of milk, otherwise your baby will take in air. If the teat becomes flattened while you’re feeding, pull gently on the corner of your baby’s mouth to release the vacuum. If the teat gets blocked, replace it with another sterile teat.

Holding your baby

Hold your baby fairly upright for feeds, with their head supported so that they can breathe and swallow comfortably.

Babies and wind

Your baby may need short breaks during the feed and may need to burp sometimes. When your baby does not want any more feed, hold them upright and gently rub or pat their back to bring up any wind. This may be a very small amount.

Throw away unused formula

Don’t forget to throw away any unused formula or breast milk after the feed.

Go with the flow

Babies differ in how often they want to feed and how much milk they want to take. Feed your baby when they’re hungry, and don’t try to force them to finish a bottle.

Don’t leave your baby

Never leave a baby alone to feed with a propped-up bottle as they may choke on the milk.

Ask for help

If you want support or further information on bottle feeding, talk to your doctor or other mothers with experience of bottle feeding.

Common questions about bottle feeding

Why doesn't my baby settle after a feed?

If your baby swallows air while bottle feeding and is then put down to sleep, this may cause discomfort and make them cry. After a feed, hold your baby upright against your shoulder or propped forward on your lap. Gently rub their back so that any trapped air can find its way out easily. But there's no need to overdo it – wind is not as big a problem as many people think.

Why does my baby sometimes vomit after a feed?

Some babies bring up more milk than others during or just after a feed. This is sometimes called ‘possetting’ or ‘regurgitation’ or ‘reflux’. It can be upsetting when this happens, and you may be worried that something is wrong. If it happens often, or your baby is violently sick, appears to be in pain or you’re worried for any other reason, talk to your doctor.

Check that the hole in your baby’s teat is not too big – giving milk too quickly can cause sickness. Sitting your baby upright on your lap after a feed may help.

If your baby brings up a lot of milk, they may be hungry again quite quickly. Don’t force them to take more milk than they want during a feed. Every baby is different. Some prefer to feed little and often.

Could formula feeding make my baby constipated?

When using infant formula, always use the recommended amount of infant formula powder stated on the packet. Don't add extra infant formula because using too much can make your baby constipated and may cause dehydration.

If your baby is under eight weeks old and hasn’t passed a stool for two-three days, discuss this with your doctor, particularly if your baby is gaining weight slowly. Your baby should be gaining weight and have wet and dirty nappies.

Infant formula and allergies

If you think your baby might be allergic to infant formula, talk to your doctor. They can prescribe special formula feeds called extensively hydrolysed protein feeds.

Some infant formula is labelled as hypoallergenic, but these are not suitable for babies with a diagnosed cow's milk allergy. Always talk to your doctor before using hypoallergenic or soya-based infant formula, as babies who are allergic to cow's milk may also be allergic to soya.

 

Sterilising baby bottles

 

There are several ways in which you can sterilise your baby’s feeding equipment. For example, by using a cold water sterilising solution, by steam sterilising or by sterilising by boiling.

The following instructions apply to all feeding equipment you use for your baby, whether you are using expressed breast milk or infant formula.

Remember, before sterilising, always:

• Clean the feeding bottle and teat in hot, soapy water as soon as possible after a feed, using a clean bottle brush.
• Rinse all your equipment in clean, cold running water before sterilising.

 

Cold water sterilising solution

 

• Follow the manufacturer’s instructions.
• Change the sterilising solution every 24 hours.
• Leave feeding equipment in the sterilising solution for at least 30 minutes.
• Make sure that there is no air trapped in the bottles or teats when putting them in the sterilising solution.
• Keep all the equipment under the solution with a floating cover.

 

Steam sterilising (electric steriliser or microwave)

 

• It is important to follow the manufacturer’s instructions as there are several different types of sterilisers.
• Make sure the openings of the bottles and teats are facing down in the steriliser.
• Manufacturers will give guidelines on how long you can leave equipment that you are not using immediately (straight after sterilising) before it needs to be resterilised.

 

Sterilising by boiling

 

• When using this method, care must be taken to ensure safety and prevent scalds or burns. Hot pans and liquids should not be left unattended, especially if children are present.
• Make sure that whatever you sterilise in this way is safe to boil.
• Boil the feeding equipment in water for at least 10 minutes, making sure that all items stay under the surface of the water.
• Remember that teats tend to get damaged faster with this method. Regularly check that teats and bottles are not torn, cracked or damaged.
• Wash your hands thoroughly. Clean and disinfect the surface where you will put together the bottle and teat.
• It is best to remove the bottles just before they are used.
• If the bottles are not being used immediately, they should be put together fully with the teat and lid in place. This is to prevent the inside of the sterilised bottle from being contaminated, along with the inside and outside of the teat.

 

Combining breast and bottle feeding

 

Feeding with breast and bottle

You may want to combine breastfeeding with bottle feeding. For example, if you:

• are breastfeeding and want to express milk to give your baby by bottle
• want to breastfeed for some of your baby’s feeds but give infant formula for one or more feeds by bottle
• are bottle feeding your baby and want to start breastfeeding

If you're introducing infant formula, this will reduce the amount of breast milk you produce. It may make breastfeeding more difficult, especially in the first few weeks, because your body will make less milk.

Introducing infant formula

If you choose to introduce infant formula, it’s best to do it gradually to give yourself time to adapt and to give your body time to reduce the amount of milk it makes. It usually helps to give the first few bottles when your baby is happy and relaxed – not when they're very hungry.

It may also help if someone other than you gives the first feeds, so that your baby is not near you and smelling your breast milk. It can take your baby a little time to get used to the bottle, so keep trying and don’t force the baby to feed.

If you're going back to work, think about how you'll do it. Start a few weeks beforehand to give both of you time to get used to it. You may find that you don’t need to introduce a bottle if your baby can drink milk from a cup and you can breastfeed when you're at home.

Choosing to restart breastfeeding

Breastfeeding is the healthiest way to feed your baby. If you decide not to breastfeed or have stopped breastfeeding, it is possible to restart. This can be difficult because your milk supply will naturally reduce once you aren't breastfeeding, but it can increase again to meet your baby's needs.

If you want to reduce the number of bottles and breastfeed more:

• Holding and cuddling your baby in close contact (skin to skin) as much as possible will give you and your baby the time and opportunity for breastfeeding to happen more easily.
• This stage can take some time while your baby builds up feeds little and often.
• When your baby comes off the breast, offer the second. It doesn’t matter if they're not interested or don’t feed for long. This is OK. Start with that breast next time as it helps to boost your milk supply.
• Talk to your midwife, health visitor or trained volunteer (peer supporter) about ways to reduce the amount of infant formula or expressed milk.
• As your milk supply increases, you can gradually decrease the amount of infant formula or expressed breast milk. Some mothers find that it helps to do this one bottle at a time until that feed is replaced by a breastfeed.
• If you've been expressing milk for most of your baby’s feeds, it's often helpful to carry on so that you keep your supply high during the changeover period.

 

Making up infant formula

 

 

 

 

Bacteria in infant formula

Even when tins and packets of powdered infant formula are sealed, they can sometimes contain bacteria such as Cronobacter sakazakii (formerly known as Enterobacter sakazakii) and, more rarely, Salmonella. Although these bacteria are very rare, the infections they cause can be life-threatening.

To reduce the risk of infection, make up each feed as your baby needs it, using boiled water at a temperature of 70ºC or above. Water at this temperature will kill any harmful bacteria that may be present.

Make up feeds, one at a time, as your baby needs them.

Always use boiled water at a temperature of at least 70ºC, but remember to let the feed cool before you give it to the baby.

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 cleaned and sterilised before each feed to reduce the chances of your baby falling sick or getting diarrhoea.

It is best to use boiled drinking water from the tap to make up a feed.
Do not use artificially softened water or water that has been previously boiled.

Bottled water

B

ottled water is not recommended to make up a feed as it is 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 is not usually sterile, so it will still need to be boiled, like tap water, before you prepare the feed.

A step-by-step guide to preparing a powdered-formula 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 70ºC.
• 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 the tap).
• 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 correct amount of water that 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 manufacturer’s instructions, and level it off using either the flat edge of a clean, dry knife or the leveller provided. Different tins of formula come with different scoops. Make sure you use only the scoop that is enclosed with the powdered infant formula that 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 dissolved.
• Step 12 It is important to cool the formula so it is not too hot to drink. Do this by holding the bottom half of the bottle under cold running water. Make sure that the water does not touch the cap covering the teat.
• Step 13 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 14 If there is any made-up infant formula left after a feed, throw it away.

 

Dos and don'ts

 

• As manufacturers’ instructions vary as to how much water and powder to use, it is important to follow the instructions very carefully.
• Do not add extra powdered infant formula when making up a feed. This can make your baby constipated and may cause dehydration. Too little powdered infant formula may not provide your baby with enough nourishment.
• Do not add sugar or cereals to the feed in the bottle.
• Never warm up infant formula in a microwave as it can heat the feed unevenly and may burn your baby’s mouth.

 

Types of 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.

 

Different types of infant formula

 

Infant formula is available in two forms:

• Ready-to-feed liquid infant formula, 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.

Unless your doctor 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 doctor will be able to discuss this with you.

 

Casein-based infant formula

 

Infant formula that is mostly based on casein is thought to take your baby longer to digest than whey-based formula. It is not recommended for young babies. There is little nutritional difference between this formula and first infant formula. Although it is often described as suitable for ‘hungrier babies’ there is no evidence that babies settle better or sleep longer when fed this type of formula.

 

Follow-on formula

 

This is also casein-based and should never be fed to babies under six months old. Research has found no clear benefit from its use. However, the labels on this formula can look very similar to those on first infant formula, so read them carefully to avoid making a mistake.

 

Other formulae

 

Some follow-on formula has cereal added to it, and is described as a ‘nighttime feed for babies’. This type of formula is not necessary and there is no evidence that babies settle better or sleep longer when fed this. It should never be given to babies under six months old.

Soya infant formula is made from soya beans, not cow’s milk. Do not use soya formula unless it has been prescribed or recommended by your doctor. If your baby is diagnosed as being allergic to cow’s milk, your doctor will prescribe an appropriate infant formula with fully hydrolysed proteins. Infant formula with partially hydrolysed proteins is available in the shops, but this is not suitable for babies with a cow’s milk allergy.

 

Types of milk to avoid

 

Not all milk is suitable for feeding babies. You should never give the following types of milk to a baby under one year:

• condensed milk
• evaporated milk
• dried milk
• sheep’s milk
• goat’s milk
• other types of drinks known as ‘milks’, such as rice, oat or almond drinks
• cow’s milk as a drink

Infant formula: common questions

 

How often should I feed my baby?

 

Newborn babies may take quite small amounts of infant formula to start with. However, by the end of their first week, most will need around 150 to 200ml per kilo of the baby’s weight per day, until they are six months old. This amount will vary from baby to baby.

Although most babies settle into a feeding pattern, they vary in how often they want to feed and how much they want to drink.

Feed your baby when they show signs that they want it. Babies tend to feed little and often, so they may not finish their bottle. However, a big feed does not mean that your baby will go longer between feeds.

 

How will I know if my baby is hungry?

 

 

After a while, you will get to know the signs that show your baby is ready to feed:

• Your baby will start to move about as they wake up.
• They’ll begin to move their head and mouth around.
• They’ll find something to suck, usually their fingers.

Try to feed your baby before they cry, as this is a late sign of hunger. 

 

How do I know if my baby is getting enough infant formula?

 

 

Your baby’s weight gain and the number of wet and dirty nappies will help to inform you as to whether your baby is getting enough formula.

Your baby should produce around six wet nappies a day a few days after the birth. Nappies should be soaked  through with clear or pale yellow urine, or feel heavy.

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 (poo).

Your baby will usually be weighed (naked) at birth and again after around 5 and 10 days. Once feeding is established, healthy babies need to be weighed no more than once a month up to six months of age, and again at one year.

 

What do I need if I’m feeding away from home?

 

 

If you need to feed your baby away from home, take with you:

• a measured amount of infant formula powder in a small, clean and dry container
• a vacuum flask of hot water that's just been boiled
• an empty sterilised feeding bottle with cap and retaining ring in place, which can be removed when you're ready to make up the feed

Make up a fresh feed only when your baby needs it. The water must still be hot when you use it, otherwise any bacteria in the infant formula might not be destroyed. Remember to cool the bottom half of the bottle under cold running water before you feed it to your baby.

Alternatively, you could use ready-to-feed liquid infant formula when you're away from home.

The vacuum flask does not need to be sterilised but should be clean, and only used for your baby. The boiling water should kill any bacteria present in the flask. If the flask is full and sealed, the water will stay above 70C for several hours.

 

What if I need to transport a made-up feed?

 

 

If it isn't possible to follow the advice above or if you need to transport a feed (for example, to a nursery), prepare the feed at home and cool it for at least one hour in the back of the fridge.

Take it out of the fridge just before you leave and carry it in a cool bag with an ice pack, and use it within four hours. If you do not have an ice pack, or access to a fridge, the made-up infant formula must be used within two hours.

• If made-up formula is stored in a fridge, use within 24 hours.
• If made-up formula is stored in a cool bag with an ice pack, use within four hours.
• If made-up formula is stored at room temperature, use within two hours.