Bottle Feeding your Baby
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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.
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.
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 ‘regurgitation’ or ‘reflux’. 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 GP.
Check that the hole in your baby’s teat is not too big – milk flowing out 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 health professional or GP, particularly if your baby is gaining weight slowly. Your baby should be gaining weight and have wet and dirty nappies.
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 before it needs to be resterilised
Sterilising by boiling
- 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 Expressed Breast Milk from a Bottle
Feeding with breast and bottle
Sometimes you may need to combine breast feeding with bottle feeding for example 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.
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 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.