Bottle feeding tips and advice

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”.

The organisation 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. 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."

How much milk should a baby drink?

According to the NHS, most babies will need around 150 to 200ml of milk per kilo of body weight over 24 hours.

You’ll be feeding your baby frequently to start with (about eight to 12 times a day) and should aim to give about 70ml per feed.

This will vary from baby to baby and, as they get older, they’ll settle into their own feeding pattern. You’ll start to recognise early feeding cues such as their hand in their mouth and will also know when they've had enough.

By the time your baby is six months old, he’ll likely be taking around 900ml of milk per day and roughly 200 to 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 to 600ml a day up to 12 months and 350 to 500ml after.

One rule of thumb is to feed your baby when they show signs that they're hungry. If you find yourself emptying out a little bit of formula or breast milk after feeding, don't worry. Babies eat little and often, so you'll know your baby is eating enough if they are gaining weight, and weeing and pooing regularly.

Your may need to alter how much your baby drinks if they're poorly, teething or experiencing a growth spurt.

What do I need for bottle feeding?

1. Bottles

Newborns feed eight to 12 times a day so it’s a good idea to have the same amount of baby feeding bottles on hand. Four-ounce bottles will suffice for feeding newborns.

If you are planning to combine breast- and bottle feeding, otherwise known as mixed feeding or combination feeding, then you won’t require quite as many bottles.

Mumsnet-recommended baby bottles:

• MAM Easy Start Anti-Colic Bottle, £9.50 from Amazon

• Lansinoh mOmma Baby Bottle, £11.95 from Amazon

• Philips Avent Natural Baby Bottle, £8 from Amazon

2. Teats

Try to have one teat for every bottle to save you time. If you're introducing a bottle to a breastfed baby, then you might find it helpful to use teats that are designed to mimic the shape of the nipple.

Mumsnetters have plenty of advice on the best bottles and teats to use.

3. Bottle and teat brush

This will make cleaning your bottles easier and should, ideally, be used solely on bottles and teats for extra hygiene.

Mumsnet-recommended bottle and teat brushes:

• Philips Avent Bottle and Teat Brush, £8.60 from Amazon

• Boots Bottle and Teat Brush, £3.49 from Boots

4. Sterilising equipment

During your baby’s first year, their immune system is still developing, which makes them more prone to infections.

Sterilising your baby’s bottle and teats will help protect them from potential bugs, although you can sterilise without buying special equipment to do so.

Mumsnet-recommended baby bottle sterilisers:

• Tommee Tippee Super-Steam Advanced Electric Steriliser, £34.99 from John Lewis & Partners

• Medela Quick Clean Microwave Bags, £12.99 from Amazon

• Milton Cold Water Steriliser, £12.79 from Amazon

5. Formula or breast milk

If you’re using formula, you’ll need to stock up. However, babies who are bottle fed don’t necessarily need to take formula. You can also feed your baby expressed breast milk in a bottle.

Related: Read our reviews of the best sterilisers

How to bottle feed a baby

1. Position them well

Sit your baby on your lap at a 45-degree angle to you with their head resting in the crook of your arm. You could also bend your knees and prop your baby up to face you. Support their head at all times.

Holding your baby upright makes it easy for them to swallow and feed at the same time. Never feed your baby a bottle when they are lying down as the fast flowing milk could cause them to choke.

Treat bottle feeding as if you are breastfeeding, using it as an opportunity to cuddle and bond with your baby.

2. Bring the bottle to your baby's lips

Place the teat on your baby's 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 your baby swallowing air, which will give them wind.

Your baby should open their mouth with their tongue down and take the teat. They'll then begin to suck and swallow. Keeping the bottle at an angle will slow the flow of milk so that they can pause for a breather when they needs to.

3. 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.

Burping your baby every five minutes during feeds as well as keeping clothing loose around their tummy and holding them upright after feeding will help with spit-ups.

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.

4. Wake your baby if they are dozing off

If your find your baby tends to doze off during feeds, consider altering their feeding schedule so that bottle feeding and nap time don't overlap.

To awake a snoozing baby, you can employ different tactics such as changing their feeding position, winding them or changing their nappy.

5. Keep an eye out for allergies

When feeding with formula, look for signs of an allergy to cow's milk.

Symptoms of an allergic reaction can include an itchy rash, swollen lips and face (including around the eyes), vomiting, stomach ache, colic, diarrhoea, constipation, a runny or blocked nose, and eczema.

An allergy to cow’s milk should always be diagnosed by a doctor.

What not to do when bottle feeding

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 symptoms of colic 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. 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 her first bottle when she's happy. Waiting until he is hungry and potentially cranky might not yield the best results.

• If she pauses during a feed, it may be because she needs a little break. Withdraw the teat for a few minutes before placing it back to her 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 and 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.

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 breast milk 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 breast milk 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 breast milk 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. 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 can help. Hydrolysed protein milk, also known as hypoallergenic milk, is only available on prescription. Partially hydrolysed protein milk is available in shops, but isn't suitable for babies with cow’s milk allergies.

• 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 breast milk – 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.

1. Boil a kettle of fresh tap water. Do not use water that has already been boiled or has been sitting there over night.

2. 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.

3. Follow the instructions on the formula packaging and pour as much water as you need into a clean, sterilised bottle.

4. 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.

5. Add the scoop of formula to the hot water. Never the other way around.

6. Add the sterilised teat and retaining ring to the bottle. Replace the cap and shake until the formula has dissolved and is thoroughly mixed.

7. 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 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.

• 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.

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