Making up powdered formula, responsive bottle feeding  and sterilising

• Any baby receiving formula milk only ever need a first infant milk (sometimes called first stage or stage 1 milk) formula for their first year if they are not breastfeeding. 

• There are powder-based formulas and ‘ready made’ formulas.

• There is no evidence that alternative formulas, like comfort formula, night time formula, Stage 2, 3, or ‘follow on’ formulas are needed.

  • These formulas tend to have higher levels of sugar in them.

• Formula should be cow’s milk based, not soya based.

• After 12 months, a formula fed baby can have full fat cow's milk instead of formula.

• A higher price of a packet of formula does not represent a superior product - All first stage formulas in the UK are regulated to have the same basic nutritional composition. Therefore there is no advantage to buying the most expensive.

  • This means that, although companies may get the nutrients they add in from differing sources, they are very similar and nutritionally adequate for an infant.

  • Some companies choose to add some non-mandatory ingredients.

• Families do not need to stick to one brand of first infant milk (formula).

• There is only one Vegetarian formula on the UK market and no Vegan option.

• Ready made formula is expensive and uses single-use plastic.

  • Parents may find them convenient on occasions, such as going out for the day. Once opened, use within one hour. As with powdered formula, ensure the milk is ‘first stage’ formula.

​​

Powdered Formula preparation:​​​

1. Wash your hands

2. Empty the kettle and refill with 1 litre of tap water.

   • Do not use filtered or bottled water.

3. Boil the kettle.

4. Once boiled, leave the water in the kettle for a maximum of 30mins.

   • This is because the water needs to be over 70 degrees but not boiling.

   • If too hot, some of the nutrients in the powder will be killed. If not hot enough (ie under 70degrees) then the harmful bacteria in the powder will not be killed.

   • If you are boiling less than 1 litre then it will take much less time to cool the water - excellent details on First Steps https://www.firststepsnutrition.org/making-infant-milk-safely 

5. Clean your surfaces with disinfectant

6. Wash your hands

7. Take out the sterilised bottle, lid, teat and screw lid from your steriliser, avoiding handling the teat

8. Place on cleaned surface

9. Pour the boiled water into the bottle to the amount you want to make - be precise with the volume

10. Add the correct amount of scoops of powder per ounce to the water, following the manufacturer's guidelines

    • Do not compact the powder down, and do not overfill the scoop

    • Gently scrape the filled spoon on the inner edge of the packaging to level the scoop before adding to the water

11. Put the teat into the screw ring. Only touch the edge of the base of the teat.

12. Screw the ring onto the bottle (with lid covering teat)

13. Gently shake the bottle to disperse the powder equally

    • The formula will be too hot at this point and will need cooling down before giving it to the baby. Either run it under cold water or put it in a pot of cold water. Test a drop or two of milk on your wrist. The right temperature is body temperature.

Further tips:​

• Always make up each bottle as it is needed

• Do not make several feeds in the morning and store in the fridge to use at a later date.

• Never heat formula in the microwave due to creating ‘heat spots’.

• If formula is made up, and it hasn't touched baby’s mouth, there is two hours (from it being made) to use it before it needs to be discarded.

• When going out, families can take boiling water in a full 500ml vacuum flask. This should keep the water above 70°C for approximately 3 hours. Take the correct amount of formula powder in a sterile container. Some hot/cold flasks last for longer than 3 hours. Check with flask/bottle manufacturer.

 

Sterilising 

• Sterilising a baby’s feeding equipment for their first 12 months is very important to help avoid illness.

• There are three main options for sterilising:

  • boiling items, a cold water sterilising tank or steam sterilising.

• Whichever method chosen, ensure the manufacturer's instructions are followed.

• Before sterilising, wash up all feeding equipment in hot soapy water, using a bottle brush, ensuring all the small spaces and ridges are cleaned.

  • Teats can be turned inside out to help clean them thoroughly.

  • The bottle brush should not be used for any other household cleaning.

  • Rinse items under cold, running tap water. The equipment is now ready to sterilise.

  • An alternative to hand washing is using the dishwasher. Put the items facing downwards so that they are cleaned well. Items still need to be sterilised after.

  • Information on all three sterilising options are on the NHS website: How to make up baby formula - NHS

​​

Formula preparation machines

• These machines ARE NOT SAFE to use

  • They have been found to cause stomach upsets in babies.

• There are also now ‘Baby Kettles’ on the market. For safety information, see Making up bottles of infant formula from hot taps and baby kettles

 

Responsive bottle feeding

• Families used to be advised to bottle feed a certain amount of milk to their baby, at certain intervals throughout the day - such as every 3 or 4 hours, even if their baby was hungry before that time. Families were told to cradle baby in their arms, with the bottle teat pointing downwards into their mouth.

  • This often resulted in babies being overfed.

  • This in turn can lead to obesity and other health problems.

• Research now shows us that there is a different way of bottle feeding babies that is better for their physical and emotional development. This is called responsive bottle feeding.

• Responsive bottle feeding encourages parents to be led by their baby as to when to feed baby and how much to give them

• It enables baby to pace their own drinking and how much they drink

• How baby and bottle is held is important so a baby can pace their own drinking - see below

• Responsive bottle feeding helps optimise a baby's brain development and emotional health, alongside strengthening their attachment to their caregivers.

• Who can bottle feed a baby?

  • ​Ideally limit the number of people who bottle feed a baby to the primary caregivers. This helps with bonding.

• What bottle and teat should be used?

  • ​Product advertising will tell you that a particular teat is best, or most like a mother’s breast. This is inaccurate, however there are certain teat styles that are preferable over others.

  • Important considerations are as follows:

    • How the bottle and baby are held during feeds is important (see How should a baby be bottle fed?)

    • The teat needs to be a ‘slow flow’ teat, whatever the age of the baby

    • Ensure a deep latch onto the bottle teat

    • Avoid slanted or flattened teats

    • You may need to try several types of bottle to find the right one for your baby - start with a cheaper bottle with the above characteristics.

• When should a parent bottle feed their baby?

  • ​Feed your baby whenever a baby shows you they are hungry!

  • Baby's show you they are hungry by:

    • moving their eyes, moving their hands to their face, licking lips, making little noises

• Where should bottle feeding take place?

  • ​Feed a baby somewhere comfortable, ideally in skin contact, and with baby’s hands uncovered.

• How should a baby be bottle fed?

  • ​The Paced Bottle Feeding method is safest and healthiest for your baby.

  • Hold baby upright, with a slight recline, and close to you, in a position that they can have their head slightly tilted back.

  • Talk to them gently and have eye contact with them throughout the feed.

    • This is good for their brain development!

  • Start the feed by gently stroking the teat on their top lip. This is likely to make them gape widely.

  • Gently insert the teat into the front of their mouth, and they will suck the teat to bring it deep into their mouth.

    • It is good for them to have a deep latch to the teat.

    • Their bottom lip should be folded out and their top lip should be folded out or neutral.

    • Breastfeeding parents may find it helpful to allow the baby to suck a few times on the teat without milk in it. This is more similar to breastfeeding than when milk flows straight away.

    • Keep the bottle positioned so the milk is laying horizontally in the teat.

    • When the baby takes a pause in sucking and swallowing, keep the teat in their mouth, but gently dip the bottle so that no milk is in the teat.

    • When they start sucking again, raise the teat back to the point where the milk is horizontal.

      • If a baby is struggling with flow, or wants a break, they may splay their fingers, grimace, try to turn away or dribble milk.

• Extra bottle feeding tips:

  • Try to vary which arm you hold your baby with to help avoid them getting a flattened head on one side.

  • Never hold the baby out in front of you or ‘prop’ the bottle in their mouth or feed them when they are lying flat. This is dangerous and a choking hazard.

  • A bottle feed shouldn’t be speedy - if they finish in 5 minutes then it’s too fast! Equally, if it is consistently taking a long time, then it is worth speaking to a feeding specialist to evaluate feeding.

  • Never force a baby to finish the amount in the bottle. Follow their lead with how much they drink.

 

Formula and nappy output

• ​Formula fed babies may poo less frequently than breastfed babies.

• Poo may be thicker/firmer, darker and smellier than a breastfed baby's poo.

• Poo may be yellow to greeny-brown colour. There should be plenty (5-6+) of heavy wet nappies by the end of their first week of life.

• Urine should be pale and not smelly.

 

Helpful links:

Responsive bottle feeding video https://www.midyorks.nhs.uk/responsive-bottle-feeding/  https://www.firststepsnutrition.org/parents-carers https://breastfeeding.support/tips-to-bottle-feed-a-breastfed-baby/

https://breastfeeding.support/best-bottle-breastfed-baby/ https://infantmilkinfo.org/wp-content/uploads/2021/10/Infant-Milk-Category-Introduction_1stMilk_October2021.pdf