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Info Centre - Using infant formula: your questions answered
This information is relevant for parents who are planning to formula feed, have changed to formula feeding from breastfeeding or who intend to mix feed.
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Preparation guidelines |
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1. Firstly, clean and sterilise bottles and teats, and leave to drip-dry. |
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2. Boil enough tap water and leave to cool to no less than 70ºC - no more than 15 mins for half a litre. This is important in order to kill germs that may be present in the powder. |
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3. Clean your working surface and wash your hands with soap and water. |
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4. Pour the correct amount of boiled water into the sterilised bottle. |
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5. Using the scoop provided, add the correct amount of powder, levelling with the spatula provided. Count out loud when you are adding the scoops (so as not to miscount), or count on your fingers (so that you can be sure how much you have added if you get distracted). |
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6. Mix by gently shaking the bottle side-to-side to prevent scalds with hot milk. |
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7. Cool to the right temperature by holding the bottle under cold running water. It should feel lukewarm on the inside of your wrist. |
Q. What’s in infant formula?
A. Usually, it’s based on processed, skimmed cow’s milk, with additives such as vegetable oils, vitamins, minerals and fatty acids. There’s a contents list on all packs. Infant formula also known as baby milk.
Q. What about the different types of infant formula?
A. Most UK brands come in ‘whey dominant’ and ‘casein dominant’ formulations. These refer to the proteins. You can’t tell from the brand name which is which, so read the pack. Both can be used from birth, but ‘whey dominant’ is usually recommended for young babies, because whey proteins are easier on the digestion. ‘Casein dominant’ is labelled for ‘hungrier’ babies, because the ‘tougher’ proteins take longer to digest; in practice, it may make no difference as they contain the same amount of energy.
Q. Which is the best brand of infant formula?
A. There’s no independent comparison. It can be confusing when you see some brands say they support your baby’s immune system, and others claim to be gentle on his digestion although the evidence for this is open to question. Whichever you choose can’t be like breastmilk, but all formulas must meet legal requirements to support adequate growth and nutrition. For healthy babies, which brand is not normally a major concern.
Q. Can I change my baby’s formula?
A. Traditionally, parents were advised to stick to one brand, but there’s no good evidence that changing does any harm. You can try out different formulas, but stick to the mainstream types. A few babies may do better with special formula, but this needs medical advice. Soya milks are based on glucose rather than lactose and they contain levels of aluminium and phyto-oestrogen that could be harmful in the long term. There are other formula milks that can be prescribed by paediatricians for non-breastfed babies with health problems related to cow’s milk.
Q. What are the rules about safe preparation?
A. Powdered formula is not sterile, and babies need protection against contamination. In particular, the bacteria enterobacter sakazakii and salmonella can both cause rare but very serious illness. Making up one bottle at a time, using enough hot water, can reduce the risk. Follow the guidance on this sheet. You can use the more expensive ready-to-feed milk instead, but you’ll still need to keep bottles and teats sterilised.
Q. What sort of bottles and teats should I use?
A. Whichever you and your baby prefer. Your midwife or health visitor can guide you. Worn bottles and teats need replacing, because it’s not possible to keep them clean. Concerns have been raised about the safety of bottles and teats containing Bisphenol A.
Q. What’s the best way to offer a bottle?
A. Babies need to be held securely – this helps you build a relationship, and it’s good for your baby to enjoy comfort and closeness when feeding. Let your baby set the pace, and remember, babies are different in the amounts they take, and how often they feed.
Q. Does formula make a difference to my baby’s health?
A. Formula fed babies have a higher risk of infections and medical conditions, and the best health outcomes are seen in babies given nothing but breastmilk for the first six months, when of course breastfeeding can continue alongside other foods. So the answer is ‘yes, it does make a difference.’ However, formula doesn’t ‘wipe out’ the positives of breastmilk, and whatever breastmilk your baby gets is good for him.
Q. If I use formula, how can I continue to breastfeed?
A. Generally speaking, the more milk your baby takes, the more you make. Giving formula can mean your baby comes to the breast less often. Result? You make less milk because the production isn’t stimulated.
So the first thing is to check formula is the only option for you. If your baby needs more milk than he can get direct at the breast, you may be able to express your own milk.
If you use formula, you can minimise the impact on your supply by expressing your breastmilk (to make your body ‘think’ the baby is taking the milk), and by keeping the total formula amount as small as you can. Usually, you’d offer it after a breastfeed. You can normally return to full breastfeeding when everything is ok – you may need help to ‘fix’ the breastfeeding problem. These are very general guidelines, though. A few mothers and babies hit a breastfeeding crisis; for instance, when formula is needed to prevent or deal with dehydration, and/or to ensure the energy to feed effectively on the breast. With support, you can still return to full breastfeeding.
Q. What about negative feelings towards formula?
A. If you planned to fully breastfeed, you might feel unhappy about using formula, and even guilty or angry. You might think people are criticising you. In fact, you deserve the same support as any other mother, something most sensitive people understand. Breastfeeding can be a real challenge, and there are times when mothers and babies need the option of formula. If you’re feeling low about using formula, share this with someone who can help you feel more positive. You can call the NCT breastfeeding line on 0300 33 00 771. Remember, you can put your baby to your breast whenever you want, even if you decide breastfeeding isn’t for you, and whether or not your baby actually breastfeeds; you can give your baby the closeness of skin to skin contact, and give the bottle like that, too. Retaining these special moments with your baby may help ease your feelings.
Tips
Avoid using the water as soon as it has boiled, in case of scalds. Also, some powdered formulas don’t dissolve well in just-boiled water.
Use the right amount of powder and water, to avoid problems with constipation or dehydration (too much powder) or poor weight gain (too much water). Your baby may need a smaller feed than the guidance on the pack if he also has breastmilk, so consult your midwife or health visitor.
Discard unused feed within two hours.
The safest way to make up feeds is one at a time with water that has cooled to no less than 70ºC. If you need to make feeds in advance, put some boiled water into a sterilised vacuum flask. When away from home, take the flask, together with the right amount of powder in a cleaned, sterilised and dry plastic container and the cleaned, sterilised bottle. Make up the feed, and cool the bottle before feeding it to your baby.
Bottles
Baby feeding bottles can be used to give expressed breastmilk or formula to a baby when you are not with your baby to breastfeed or when you are using formula.
There are many different types of feeding bottle on the market but there is no published evidence that shows any one bottle design is any better than another. Bottles may be made of glass or plastic.
Glass bottles
Glass bottles have the advantage of being clear so the milk inside can be seen and they are easy to clean and sterilise and are much harder to scratch. However they are heavy and may smash.
Plastic bottles
Clear shatter proof plastic bottles have become more popular because they are less likely to create the dangers of shattered glass. You should check that the bottle does not have Bisphenol A (BPA) present in the plastic as it can leach into the milk. See Bisphenol A.
Self heating bottles
These are bottles that self-heat to around 50oC, however, in order to be sure that any bacteria in powdered milk are destroyed, it needs to be made using boiled water that is no less than 70C. Most babies are fine with milk at room temperature, so expressed breastmilk or ready to feed formula can be given without waiting.
Correct preparation of formula
To make up formula safely, milk feeds should be made up with water heated to at least 70oC. This is because formula powder is not sterile and may contain harmful bacteria.
Alternatives to feeding with a bottle
For babies from about 4 months a sippy cup or baby cup can be used for occasional feeds rather than a bottle. From 6 months most babies will be happy to use a cup for most daytime milk feeds. See also Breastfeeding for Bottle Fed Babies.
If you would like further information about when to introduce solids to your baby, please see "When do I introduce solids to my baby?".
