Bottle feeding - everything you need to know
The Royal College of Midwives has confirmed its stance on infant feeding, stating that the decision whether to breastfeed or bottle feed should be entirely the mother's. She should be fully supported with relevant and unbiased information and must be free to make her decision without the judgement of medical staff, family or friends.
The Royal College of Midwives (RCM) has confirmed its position on infant feeding, stating that “the decision of whether or not to breastfeed is a woman’s choice and must be respected”. Midwives are being told that the decision to bottle feed, whether exclusively or in tandem with breastfeeding, is a woman's right.
RCM has also called for further investment in postnatal care, so that every woman gets the information and support she needs to make informed choices about feeding her baby, however she chooses to do so. It advises that balanced and relevant information be given to parents choosing to formula feed their babies, to enable them to do so safely, with support and without judgement.
RCM’s Chief Executive Gill Walton said: “Evidence clearly shows that breastfeeding brings optimum benefits for the health of both mother and baby. However the reality is that often some women for a variety of reasons struggle to start or sustain breastfeeding.
“The RCM believes that women should be at the centre of their own care and as with other areas of maternity care midwives and maternity support workers should promote informed choice. If, after being given appropriate information, advice and support on breastfeeding, a woman chooses not to do so, or to give formula as well as breastfeeding, her choice must be respected.
“We recognise that some women cannot or do not wish to breastfeed and rely on formula milk. They must be given all the advice and support they need on safe preparation of bottles and responsive feeding to develop a close and loving bond with their baby."
What do I need for bottle feeding?
Newborns feed about eight to 12 times a day so it’s a good idea to have about as many bottles – it saves having to wash as you go. Let’s face it, when a baby is feeding every two to three hours, there’s not much time for anything else.
Four-ounce bottles will suffice for feeding newborns. Older babies feed every three to four hours but their feeds are bigger so then you’ll need six to eight bottles that hold eight ounces each. If you are planning to mix feed – a combination of bottles and breastfeeds – then you won’t require quite as many bottles.
Try to have one for every bottle to save you time. If you are introducing a bottle to a breastfed baby, then you might find it helpful to use teats which are designed to mimic the shape of the nipple.
Bottle and teat brush
This will make cleaning everything out easier and can be kept only for use on bottles and teats, for extra hygiene.
During your baby’s first year his immune system is still developing, making him more prone to infections. Sterilising your baby’s bottle and teats will help protect him from potential bugs, although you can sterilise without buying special equipment to do so. Find out what Mumsnetters think about different sterilisers on the market.
How do I sterilise my baby’s bottle?
Before sterilising any equipment, wash it all in hot soapy water using the bottle or teat brush to remove any dried-on milk. Make sure you clean all parts of the bottle as well as the teat and the formula scoop. Keep your brushes clean and use them only for cleaning feeding equipment – not for your washing up. You can then sterilise your feeding equipment in a number of ways.
- Boiling. You’ll need to submerge all bottles, teats and any other equipment in a pan of boiling water for 10 minutes. Make sure all parts are covered with water. Teats are more prone to damage using this method.
- Sterilising solution. You can buy this in tablet or liquid form. You’ll need to dilute it in cold water according to the manufacturer’s instructions. You can also purchase a special sterilising container in which to dilute the solution. Leave the equipment in the solution for at least 30 minutes and discard it after 24 hours. I was told that sterilisers weren’t necessary – but bought an electric steriliser anyway and it was really easy.
- Steam sterilising. You can do this using a microwave or an electric steriliser. This can be a quick way to sterilise all your equipment in one go with most sterilisers able to take up to six bottles.
What type of formula should I give my baby?
The baby food aisle is packed full of different products and it can be difficult to decide which formula is right for your baby. Formula typically comes as a dry powder that you make up according to the instructions. You can also buy a pre-mixed liquid version of most formulas which are convenient if you’re on the go but they do cost more and need to be used straight away once opened.
Most formula milk is made with cow’s milk which has been modified to make it easier for babies to digest. In some cases, it is also supplemented with proteins and fatty acids that are found in breastmilk in order to replicate some of the benefits of breastfeeding.
Cow’s milk contains two types of protein: casein and whey. Casein is lumpier and is heavily present in ‘hungry baby’ milk as it leaves your baby fuller for longer. Whey is more watery and easier for babies to digest.
Your midwife or health visitor will normally recommend first infant formula as your baby’s first milk. He can drink this from birth and throughout his first year. You can continue to give him this while introducing solids.
There are also several alternative milks readily available:
- Premature baby formula. If your baby was born early then you can find formula specially designed for premature babies. This is usually supplemented with minerals and vitamins that your little one will need to support his growth. You can use this in conjunction with your own breastmilk or instead of it.
- ‘Hungry baby’ milk. You should only feed your baby this if advised to do so by your midwife, health visitor or GP. If your baby is showing an increased appetite, don’t assume it’s because he needs ‘hungry’ milk. It’s more likely down to a temporary growth spurt. Giving hungry milk unnecessarily can cause digestive problems and an upset stomach. Always get advice first.
- Goat’s milk formula is also available as a first milk. Many people mistakenly think that goat’s milk is an alternative for babies with a cow’s milk allergy. But both cow’s milk and goat’s milk contain the same protein, meaning that if your baby is allergic to one, he’ll be allergic to the other.
- Soya milk formula is often recommended for babies who are allergic to cow’s milk. You should only use this if it’s been recommended by your doctor as it contains the sugar glucose, and can cause dental decay in babies. You should not feed soya milk formula to babies under six months.
- Hydrolysed protein milk. The proteins in cow’s, goat’s and soya milk are different from those in breastmilk and some babies may struggle to digest them. In hydrolysed protein milk, the proteins are broken down, making it gentler on small babies’ digestive systems. If your baby has an allergy to cow’s milk, they may find hydrolysed protein milk easier to digest. These milks also tend to be lactose-free so if your baby’s allergy is to the sugar (lactose) in cow’s milk, hydrolysed protein milk will definitely help. An allergy to cow’s milk or another food should always be diagnosed by a doctor rather than assumed. Hydrolysed protein milk, also known as ‘hypoallergenic milk’, is only available on prescription so you will need to see your doctor first. Partially hydrolysed protein milk is available in shops but is not suitable for babies with cow’s milk allergies as the proteins have not been fully broken down and lactose is still present.
- Staydown milk. This is thickened formula designed for babies who have reflux. Only use on the advice of your midwife or health visitor.
- Cow’s milk. From the age of one, whole cow’s milk is suitable for your baby. They can have it in food when weaning from six months (eg in cheese or as a white sauce) but not as their main milk. From the age of two, they can drink semi-skimmed milk but until that point they need the extra calories full fat provides. Do not give cow’s milk to any baby under the age of 12 months in place of formula or breastmilk – their digestive system is not yet ready for it.
Other milks marketed as follow-on milk, bedtime milk or toddler milk are not thought to be necessary and there is no evidence that they are any more beneficial than first milk or cow’s milk.
How do I prepare a bottle of formula?
Before making up formula make sure you wash your hands and only use equipment that has been sterilised.
- Boil a kettle of fresh tap water. Do not use water that has already been boiled or has been sitting there over night.
- Once the water has boiled, leave it to cool for while (no longer than 30 minutes). The water that you use to make up formula should never be cooler than 70°C. Keeping the water above this temperature helps to kill off any bacteria.
- Follow the instructions on the formula packaging and pour as much water as you need into a clean, sterilised bottle.
- Use the scoop that comes with the formula to measure out how much you need. You should level off the scoop rather than heap it. Scoops come in different sizes so only use the one that comes with that particular formula.
- Add the scoop of formula to the hot water. Never the other way around.
- Add the sterilised teat and retaining ring to the bottle. Replace the cap and shake until the formula has dissolved and is thoroughly mixed.
- Test the temperature of the milk on the back of your hand. It should be body temperature. If it’s too hot, run the bottle under a cold tap to cool it down.
Always throw away any unused formula at the end of a feed and never heat formula in the microwave. It will heat unevenly and the hot spots could burn your baby’s mouth.
How much formula do I need to give my baby?
Newborns need about 150-200ml of formula milk per kilogram of bodyweight, each day. You’ll be feeding frequently to start with (about eight to 12 times a day) and should aim to give about 70ml per feed.
At six months I was offering my daughter 7oz and letting her take what she wanted – sometimes it was the full 7oz, sometimes only 5oz or so.
Every baby is different and as he gets older he’ll settle into a feeding pattern. You’ll start to recognise early feeding cues such as his hand in his mouth and will also know when he’s had enough. By the time he is six months old, he’ll probably be taking about 900ml of milk per day and roughly 200-220ml per feed.
At around six months, you can also introduce solid foods to your baby’s diet. Once your baby is weaning, you can gradually reduce the amount of milk you give him to 500-600ml a day up to 12 months and 350-500ml after he’s turned 12 months.
How do I bottle feed my baby?
Position him well
Sit your baby on your lap at a 45° angle to you with his head resting in the crook of your arm. You could also bend your knees and prop your baby up against them and facing you. Support his head at all times.
Holding him upright makes it easy for him to swallow and feed at the same time. Never feed your baby a bottle when he is lying down as the fast flowing milk could cause him to choke.
Treat bottle feeding as if you are breastfeeding, using it as an opportunity to cuddle your baby and bond with him.
Bring the bottle to his lips
Place the teat on his lips and tilt the bottle so that it is almost (but not quite) parallel with the floor. Keep an angle so that the teat fills with milk and reduces the chances of him swallowing air, which will give him wind. He should open his mouth with his tongue down and take the teat. He’ll then begin to suck and swallow. Keeping the bottle at an angle will slow the flow of milk so that he can pause for a breather when he needs to.
Interrupt the feed occasionally
He may need burping during feeding and may also be getting full. Interrupting the feed also mimics the stop-start flow of breastfeeding.
If your baby is teething, then you should regularly check teats for bite marks and holes that might speed up the flow of milk and make your baby uncomfortable.
What not to do
When bottle feeding your baby, you should never do any of the following:
- Never leave him alone with a bottle propped in his mouth – this could lead to choking.
- Never mix anything in his bottle such as rusk or cereal.
- Never force a baby to finish a bottle. 'Feeding up' a small baby, especially a low-birthweight one, is associated with a higher risk of childhood obesity.
- Never give a baby 'follow-on' milk before he's six months old (if at all), no matter how big he is. His digestive system just won't be able to cope with it yet.
Common bottle feeding problems
Some babies might seem unsettled or even bring up milk after a feed. These are common problems and in most cases, they can be remedied.
- Being unsettled. If your baby is unsettled after a bottle and exhibiting colic-like symptoms then chances are he’s swallowed air and needs a good burp. A gentle rub on his back will help him to bring the air up.
- Bringing up milk. It’s a good idea to have a towel or muslin cloth handy if your baby is in the habit of bringing up milk. This may be happening because he is drinking too much milk too quickly. Consider changing to a teat with a more controlled flow. If he is bringing up a lot of milk then you’ll probably notice that he is hungry again soon after a feed. If the regurgitation of milk is accompanied by crying, it could be that he has reflux. You may need to see your doctor and consider a staydown-formula.
- Suffering constipation. If your baby is constipated following his feed, then it could be that you are mixing too much formula with water. Always stick to the manufacturer’s instructions and only use the scoop provided for measuring. If the constipation persists, speak to your GP. Formula-fed newborns usually poo up to five times a day while older babies should be producing at least one dirty nappy a day.
What should I do if my baby won’t take a bottle?
If you’re introducing a breastfed baby to a bottle, you may come across some resistance. (Try not to feel judged here – they all do it.) Bottle feeding requires a different sucking and swallowing action from breastfeeding and it may take your baby a while to get used to it.
If your baby is refusing the bottle, try these tips:
- Give your baby his first bottle when he is happy. Waiting until he is hungry and potentially cranky might not yield the best results.
- Try different teats, different temperatures and different positions. My son likes his bottle warmer than most and refuses it if it's not to the right temperature. Try getting Dad to give him the bottle, too. Slow-flow teats can help mimic the flow that a baby is used to from breastfeeding. Mumsnetters have plenty of advice on the best bottles and teats to use.
- If he pauses during a feed, it may be because he needs a little break. Withdraw the teat for a few minutes before placing it back to his lips.
- Let someone else give the first bottle. This eliminates any chance of the baby smelling your milk and wanting to latch on.
- If someone else isn’t available to give the first bottle, you could try holding your baby in a different position, such as sitting on your lap, facing away from you.
Remember that introducing bottle feeding, whether you’re just moving to one bottle a day or weaning from the breast, can require patience and persistence. While some babies take to the bottle straight away, in most cases it can take a few attempts to get a baby used to it. If your baby isn’t playing ball, don’t panic. You can always try again at another time.
Keep calm and keep your eyes on the prize – moving to bottles can feel like the end an era but it’s also the beginning of you being able to have a few hours to yourself again. Something to look forward to.