Feeding
Formula feeding, done properly
Preparation and sterilising have specific safety reasons, and the differences between products are smaller than the packaging implies.
Formula feeding is chosen or required by a large proportion of families, and the practical guidance around it is oddly under-explained given how specific the safety points are.
Why preparation matters
Powdered infant formula is not sterile.
It can contain organisms including Cronobacter, which is rare and can cause severe illness in young infants.
Which is why guidance in many countries specifies making up feeds with water that has been boiled and then left to cool to no lower than seventy degrees, which is hot enough to kill these organisms.
The feed is then cooled quickly under running water before giving.
Ready-to-feed liquid formula is sterile until opened and is the safest option for very young, premature or unwell babies where available.
The specific steps
Wash hands and clean the surface.
Boil fresh tap water and leave it no more than thirty minutes so it remains above seventy degrees.
Pour the required amount of water into the sterilised bottle first.
Add the exact number of level scoops using the scoop provided with that tin, levelled with the flat edge provided rather than packed or heaped.
Never add extra powder or extra water, since both are harmful — too concentrated strains the kidneys, too dilute underfeeds and in extreme cases causes dangerous sodium imbalance.
Seal and shake, cool under cold running water with the lid on, and test the temperature on the inside of your wrist.
Discard any feed left after two hours.
Make feeds fresh rather than in advance where possible, since storing made-up feeds increases risk.
Sterilising
Recommended for bottles, teats and any feeding equipment until around twelve months in most guidance.
Wash thoroughly in hot soapy water with a bottle brush first, since sterilising does not work on dirty equipment.
Then sterilise by steam, boiling or cold water solution, following the instructions for that method.
Keep equipment covered and sterile until used, and reassemble with clean hands.
Dishwashers clean but do not sterilise.
Choosing a formula
Where the market and the evidence diverge.
Infant formula composition is regulated by law in most countries, which means first infant formula from any manufacturer meets the same nutritional standards.
Price differences reflect branding and marketing far more than nutritional difference, and several national health bodies state explicitly that more expensive brands are not better.
First infant formula, which is whey-dominant, is suitable for the whole first year — there is no need to move to follow-on formula, and hungry baby, goodnight and toddler milks have no established advantage.
Specialist formulas — extensively hydrolysed, amino acid based, anti-reflux, lactose free — are for specific diagnosed conditions and should be used on medical advice rather than chosen.
Soya formula is not recommended for infants under six months except on specialist advice.
And plant-based drinks sold as milks are not suitable as infant formula under any circumstances.
Feeding practically
Paced responsive bottle feeding is worth knowing about: hold the baby fairly upright, keep the bottle more horizontal, let them draw the teat in rather than pushing it, and pause periodically.
This reduces the tendency to overfeed that comes from a fast flow.
Feed responsively rather than to a schedule or a volume target, and let the baby stop when they show they are finished.
Do not force the last of a bottle.
Never prop a bottle, which is a choking risk and increases ear infections.
Teat flow rate should suit the baby, and a slow flow is generally right for a newborn.
And winding is worth doing though the evidence for its effect on crying is weaker than folklore suggests.
How much and how often
Guidance gives approximate volumes based on weight, and individual babies vary considerably.
Newborns feed frequently and in small volumes, moving towards larger, less frequent feeds.
Growth spurts produce temporary increases.
The reliable indicators are the same as for breastfed babies: wet and dirty nappies, weight gain along a centile, alertness, and contentment after most feeds.
Combination feeding
Common and workable.
Introducing bottles alongside breastfeeding can affect supply, since supply depends on removal, so expressing to replace a missed feed maintains it.
Introducing a bottle is often easier around three to six weeks once breastfeeding is established, though this varies and some babies refuse bottles regardless of timing.
And a baby who refuses a bottle from one person will frequently take it from another, which is worth trying before concluding it is impossible.
General information only, not medical advice. Follow the preparation instructions on the product and consult your health visitor or a qualified clinician about feeding your baby.
