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Formula feeding—information for parents

At Mater Mothers’ Hospitals we respect your right to choose how you feed your baby and will support your decision with guidance and advice.

Choosing an appropriate formula for your baby

  • Only infant formula suitable from birth should be used.

  • A cow’s milk-based formula is suitable for the first 12 months. Only use soy-based or other alternative infant formulas on medical advice.

  • ‘Follow-on formula’ is not suitable for infants under six months of age.

  • Changing to cow’s milk is appropriate from 12 months of age while ‘toddler formulas’ are not required or recommended unless medically prescribed.

Equipment

  • Two to six large bottles.

  • Teats: shape variations offer no particular advantage unless your baby prefers that shape. However the teat shape best suited to a baby moving between bottle and breast is a long straight teat.

  • Bottle brush (soft).

  • Airtight container for storing clean equipment.

Cleaning feeding equipment

All equipment used for formula feeding should be washed and disinfected (sterilised) as outlined in the following steps.

General cleaning

  • Rinse equipment with cold water

  • Wash thoroughly with detergent and warm water:

    • bottles—use a bottle brush to ensure all milk residue is removed

    • teats—force a little soapy water through the feeding hole to ensure it is not blocked.

  • Rinse thoroughly with cold clean water and then sterilise all equipment using either the boiling or steam methods.

  • Store sterilised equipment in an airtight container

  • Careful cleaning and safe storage of equipment should continue as long as bottles and teats are used.

Sterilising feeding equipment

Boiling

  • Place all equipment into a large saucepan and cover with water making sure that all air bubbles are removed from the equipment.

  • Place a lid on the saucepan and bring to the boil.

  • Boil for five minutes.

  • Allow the equipment to cool in the saucepan, with the lid on, until it is just hand-hot before removing it.

  • Drain any water from the equipment, and air dry on clean paper towel.

  • Store in a clean container in the fridge for 24 hours.

  • If not used within 24 hours repeat cleaning, including the storage container.

Steam

When using a steam steriliser at home, always follow the manufacturer’s instructions, carefully, and then follow the steps for drying and storing, as per ‘general cleaning’.

Preparing formula safely

Preparing the water

  • To prepare the water, empty the kettle or electric jug, refill it with water and bring to the boil.

  • Kettles or jugs without an automatic cut off should be turned off within 30 seconds of boiling.

  • Allow the water to cool at room temperature for no longer than 30 minutes after boiling.

  • Note: Bottled water is not sterile and should be boiled before use.

Preparing the formula

  • Always wash hands and clean work surfaces before preparing formula.

  • The recommended and safest way of making formula is one bottle at a time, in the bottle. This reduces the potential for contamination and the possibility of error when counting scoops of formula.

  • Formula is designed to remain at a constant strength. As your baby grows the amount of formula should increase NOT the strength. Never, for any reason, add any more scoops than specified in the package directions, unless specifically instructed by a qualified paediatric dietitian (this will only be necessary for babies with certain special health needs). Also, never dilute formula by adding more water than specified in the package directions.

  • Pour the required amount of prepared water into a clean feeding bottle.

  • Always use the scoop provided in the tin of formula.

  • Fill the measuring scoop supplied with the tin with formula, tap to remove air bubbles then level off using a sterilised plastic knife, or the levelling device on top of the tin.

  • Return the dry scoop back to the tin after use. Do not wash as this may introduce inadvertent moisture collection contamination if not adequately dried.

  • Seal the bottle with a cap and disc and shake gently to mix the formula thoroughly.

  • Check the expiry date on formula containers and discard them if they are out of date.

  • Discard any open tins of formula after one month.

Storing prepared formula

  • If not using immediately, store prepared formula in the fridge at the back where it is the coldest. Never store prepared formula in the fridge door.

  • It is preferable to prepare the formula at each feed time. If it needs to be prepared in advance, it must be refrigerated below five degrees Celsius, kept in the cabinet of the fridge (rather than the door), and used within 24 hours.

Re-warming refrigerated formula

  • To warm formula, stand the prepared bottle in warm to hot water. To ensure it heats evenly, swirl the bottle to ensure the temperature is evenly distributed.

  • Microwaving is not recommended for warming formula as the milk heats unevenly and potential for ‘hot spots’ may burn baby’s mouth.

  • Time taken to warm formula should not exceed 10 minutes.

Transporting formula

  • If travelling, it is preferable to prepare the formula at your destination.

  • If this is not possible, cool the prepared formula to five degrees Celsius prior to transporting, and then transport in a cool bag with ice packs to maintain the temperature. Use within two hours.

  • If the destination is reached within two hours, the cooled milk may then be stored in a fridge for up to 24 hours from the preparation time.

  • Discard the contents of partially used bottles after one hour.

  • Discard any unused prepared formula after 24 hours.

Giving a formula feed to your baby

Feeding your baby with a bottle should be a pleasurable experience. Hold your baby close to you, encouraging eye and skin contact. Switching from one side to the other half way through the feed will encourage eye stimulation and development while avoiding side preference.

  • Allow your baby to demand each feed, by responding to their feeding cues.

  • Test the flow of the teat—the milk should drip steadily. The cap can be loosened slightly if the flow is too slow.

  • Test the formula temperature—sprinkle a small amount onto the inside of your wrist to ensure it is comfortably warm but not too hot.

  • Stroke baby’s lip from top to bottom with the teat. When the baby’s mouth opens to accept the teat, gently allow the teat to be drawn into the mouth rather than pushing it in.

  • The baby should have wide open lips to hold the teat deeply in the mouth.

  • As the baby begins to suck, hold the bottle in a horizontal position.

  • As the baby pauses, lower the base of the bottle so that milk no longer fills the teat while keeping the teat in the baby’s mouth.

  • As baby begins to suck again, raise the level of the bottle back to the horizontal so that milk is again available in the teat.

  • If the baby dozes and releases the teat before the bottle is empty, this signals the end of the feed.

  • The feed should not take more than one hour.

  • Formula left in a bottle after completion of a feed will be discarded and not kept for use in a later feed.

  • Never leave a baby to feed alone or with a propped bottle as this increases the risk of choking.

  • Do not put a baby to sleep while drinking a bottle as this increases the risk of ear infection and choking while the pooling of milk increases the risk of dental caries.

How much formula will my baby need?

There are many variations in the amount of formula and the number of bottles consumed by your baby each 24 hours. Information on formula containers is a guide only and does not necessarily suit every baby. Plenty of wet nappies, consistent (but not excessive) weight gain and a thriving active baby indicate that all is well. If you have any concerns about how your baby is feeding please contact your child health nurse or doctor.

Boiled water

If you choose to give your formula-fed baby additional boiled water, for example during hot weather, first ensure that your baby has had their recommended quota of correctly made formula. Use only cooled boiled water in a sterilised bottle.

Constipation

Formula fed infants are more prone to constipation. As there may be many reasons for your baby being constipated you need to discuss this situation with your doctor or child health nurse.

References

  1. Infant Feeding Guidelines for Health Workers. National Health and Medical Research Council. 2003
  2. Australian Lactation Consultants Association Victoria. Breast or Bottle. What Will You Choose? Second Edition. 2007
  3. Cleaning of infant feeding equipment. Centre for Healthcare Related Infection Surveillance and Prevention—Fact Sheet. Queensland Health. 2006
  4. Safe preparation, storage and handling of powdered infant formula. World Health Organisation. 2007 www.who.int/foodsafety/publications/micro/pif_guidelines.pdf

This publication is also available in other languages including the following:

For video resources on this topic in languages other than English, visit the Raising Children Network website.*

*Please note that Mater cannot guarantee the accuracy or appropriateness of information provided on third party websites.

© 2015 Mater Misericordiae Ltd. ACN 096 708 922

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430050
Last modified 09/8/2017.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 28/2/2014
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