Formula feeding

Breast or bottle, the way you feed your baby is your decision. Your midwife or health visitor should tell you all you need to know about formula feeding. If you have any questions, just ask.  

How do I formula-feed my baby?

The most common way to feed a baby with formula milk is from a bottle. There are lots of bottle brands and styles to choose from. Teats can be made from rubber or silicone and they vary in shape and size.

There is no evidence that one type of teat is the best. It just depends on what you and your baby prefer.

You may find that you try a few different types of bottles and teats before you settle on one that works well for you and your baby. When you are choosing, check that the milk does not drip out faster than one drop a second.

What kind of milk should I use?

There are lots of brands and types, so making a choice can sometimes feel daunting. You may notice that some formulas are sold as comfort milk (for babies with digestive problems such as colic) and ‘hungrier baby’ milk. But formula that is called “first milk” is the only milk your baby needs for the first 6 months.

Some parents feel that hungry baby milk helps babies settle better or sleep longer. But there is no evidence to support this claim. Contact your midwife or health visitor if you are thinking about giving other than first milk.

After 6 months, you can start giving your baby solid food (known as weaning) as well as feeding your baby first milk. Formula companies sell milk called ‘follow-on’ milk but this is not necessary. They can have first milk until they are a year old. After that you can drop formula and give your baby full-fat cow sheep or goats’ milk.

Talk to your midwife, health visitor or GP if you think your baby may be allergic to, or intolerant of, formula. It may be that they can prescribe a special formula feed.

Formula milk is available as:

• powder, which you make up with water
• ready-to-feed liquid.

Powdered formula is not sterile. So, you need to take extra care when making it up. Ready-to-feed formula is sterile straight from the bottle. Once it is opened, though, it must be used more quickly than a bottle you make yourself. It tends to be more expensive than powdered formula.

I used to always carry a bottle of ready-to-feed formula with me, so that I always had something if needed. It was definitely more expensive and I couldn’t afford to use it all the time, but when out and about, and especially when away on holiday, it was much more convenient for me and my baby.

Sharon

How much formula milk does my baby need?

Follow the advice on the packet. Just remember that each baby is different, so it is most important to be guided by your baby too. They will let you know when they want feeding and when they have had enough.

Look out for these signs that your baby is hungry:

• turning their head and opening their mouth (rooting)
• sucking on their fist or fingers

Try to feed your baby before they start crying. Crying is the last sign of hunger and it can be harder to feed an upset baby.

From a few days after the birth your baby should have about 6 wet nappies a day. After about a week, your baby should have at least 6 wet nappies a day, and at least 1 soft poo a day. If you are worried about how much to feed your baby then talk to your midwife or health visitor.

Can I still bond with my baby during formula feeding?

Some people who are not breast or chest feeding may worry that they are missing a chance to bond with their baby.

You can still grow a strong emotional bond with your baby while giving them a bottle. During feeds, keep eye contact with your baby, feed them skin-to-skin, chat softly to them and watch out for signals or cues of how they are feeling.

This is called responsive feeding. It means every feed can be a special time for you and your baby. It also helps your baby to stay settled and comfy while feeding.

Try responsive feeding.

• Sit comfortably, hold your baby close and look into their eyes – your baby loves to lock eyes with you while feeding.
• Keep your baby fairly upright, supporting their head.
• Brush the teat against your baby’s lips. When they open their mouth wide, allow them to draw in the teat themselves.
• Keep the bottle slightly tipped, not upright, to stop the milk from flowing too fast.
• Pull gently on the corner of your baby’s mouth to release the teat if it becomes squashed during feeding.
• Offer your baby short breaks during the feed, so they have a chance to burp.
• Let your baby pace the feed – they can put their tongue over the hole to slow the flow or push the teat out of their mouth when they have had enough.
• Never force your baby to feed or finish a bottle. They may show you they have had enough by splaying their fingers and toes, spilling milk out of their mouth, or turning their head away.
• Feed your baby skin-to-skin – this means having your baby on you, their bare skin next to your bare skin, with a blanket over both of you for warmth.

It is best to limit the number of people who feed your baby for the first few weeks. Keeping it to just you and your partner will help to create close bonds between you all.

How can I bottle-feed safely?

It is vital to protect your baby from infections by always cleaning and sterilising your feeding equipment.

There are a few ways you can keep feeding equipment clean and safe:

• cold-water sterilising solution
• steam sterilising using an electric steriliser or microwave
• sterilising by boiling.

Whichever method you use, make sure you:

• Wash and sterilise any feeding equipment before each feed.
• Wash your hands every time you handle feeding equipment and formula.
• Clean and disinfect the surface area you are going to use.
• Check that the bottle and teat are free from damage.
• Clean the bottle and teat in hot, soapy water using a clean bottle brush, or in the dishwasher, straight after a feed.
• Make sure bottles, lids and teats are facing downwards if you use a dishwasher. Remember, it does not sterilise equipment.
• Rinse all your equipment in clean, cold running water before sterilising.
• Do not leave a bottle of formula at room temperature for more than two hours as this allows bacteria to grow.
• Throw away leftover feeds – do not keep them for later.
• Make one feed at a time, as and when your baby needs it.
• Follow the manufacturer’s instructions if you use sterilising equipment.

Can I heat bottles in the microwave?

No. Never warm formula in a microwave. It may heat the milk unevenly, causing hot spots that can burn your baby’s mouth. Always use boiled water. Then, allow the water to cool for no longer than 30 minutes before using it to make formula. Test the temperature on the inside of your wrist, checking it feels around body temperature, before giving it to your baby.

Will adding extra powder make my baby sleep for longer?

No. Too much powder can make your baby constipated or dehydrated. Always follow the instructions on the formula packet to get the right mix of powder and water.

Is it possible to overfeed a formula-fed baby?

Yes. It can be easy to overfeed a bottle-fed baby by mistake. It’s hard for babies to control the flow of milk through a teat. Your baby needs you to help them take as much milk as they want, at the pace they want.

You can learn to take your baby's lead by:

• getting to know the signs that your baby is hungry (instead of when they just want a cuddle)
• pacing feeds with pauses so your baby has time to tell if they are full or want more milk  
• looking out for your baby’s cues that they have had enough, such as turning their head away
• not trying to persuade your baby to drink more than they want.

Talk to your midwife or health visitor if you have any concerns about how much formula your baby is drinking. 

Is it safe to make up formula feeds in advance?

It is best to make up feeds one at a time as your baby needs them. This helps to protect your baby against infections. Sometimes, though, you may need to take a feed out with you.

Make up the feed at home and cool it under a running tap or in a bowl of cold water. Then put it in the back of the fridge for at least 1 hour. Take it out of the fridge just before you leave and carry it in a cool bag with an ice pack. Use the made-up feed within 4 hours. If you cannot keep it cool, use it within 2 hours.  

As a rule, made-up formula needs to be used within:

• 24 hours, when kept in a fridge
• 4 hours, when kept in a cool bag with an ice pack
• 2 hours, when stored at room temperature.

Some parents find ready-to-feed liquid formula an easy option when they are out and about, but it can cost more. And if you transfer it into your baby's bottle, that bottle still needs to be sterilised first. You will also need to throw away any ready-to-feed formula that is left over if you cannot store it according to the instructions on the packet.

I think my baby is lactose intolerant. Should I start them on lactose-free formula?

Do not switch to a special formula unless a health professional has advised you to. Make sure you talk to your health visitor or GP if you think your baby is having a reaction to formula milk. It is rare for babies to be lactose intolerant, so something else may be making your baby unwell.  

Cows’ milk allergy

Some babies have a cows’ milk allergy, which is not the same as lactose intolerance. See your GP if you are worried that your baby has a cow's milk allergy. They can diagnose it and prescribe a special formula for your baby.

NHS has more information on cows’ milk allergy or intolerance.  

Where can I find more support and information on formula feeding?

You can ask your midwife or health visitor for advice. They are there to support you and your baby, whether you decide to breastfeed, formula feed, or combination feed.

The First Steps Nutrition Trust is an independent public health charity. It provides information and resources about eating well, including formula milks.

The UNICEF Baby Friendly Initiative provides useful resources for parents, including a guide to bottle-feeding.