Formula feeding

A first stage formula is all that your baby needs until they are one year of age, when they can then go on to drinking full fat cows milk.

Follow-on milks and growing -up milks are not needed.

All brands are nutritionally complete and very similar, with no one milk being better than another.

Useful links:

• Type of infant milk (First Steps Nutrition Trust)
• Infant milks Information for parents & carers (First Steps Nutrition Trust)

There’s no scientific evidence to suggest that offering your baby hungrier baby milks, second milks, toddler or growing up milks offer your baby any additional nutritional benefits.

Anti-reflux, comfort, lactose free, hypoallergenic and soya formula milks should only be used under medical advice from your GP and health visitor.

Good hygiene is essential when making up your baby’s formula milk. It is recommended that you make it fresh when your baby needs it, not before.

Your baby’s immune system is less developed than an adult’s, so there’s a chance they can get ill if you don’t follow the instructions and powdered infant formula is not a sterile product. By following the Department of Health guidelines for making up formula you will ensure safe and effective removal of any bacteria – this is by using water that is at least 70 degrees celsius to kill the bacteria that can cause problems.

Useful bottle feeding information link:

• Bottle feeding (Better Health Start for Life)

Here are a few simple steps to consider when making up your bottles:

Step 1. Empty your kettle and refill with at least one litre of fresh tap water.

Do not use bottled water - Bottled water isn’t sterile and contains too much sodium which can be harmful to your baby. However, if you don’t have access to tap water, you’ll have to use bottled water. To do this safely you must read the label to make sure:

• The sodium level (written as Na) is less than 200 milligrams (mg) per litre
• The sulphate level (written as SO or SO4) is less than 250mg per litre
• Remember that bottled water is not sterile so would still need to be boiled before using it

Step 2. After boiling, leave the kettle to cool for no longer than 30 minutes to ensure that the water remains above 70 degrees celcius.

Step 3. Clean the preparation area and wash your hands thoroughly.

Step 4. Place your baby’s sterilised bottle/teat on the clean preparation area. If you’ve used cold water sterilisation, shake off the excess sterilisation solution and rinse with cool boiled water from the kettle.

Step 5. Pour boiled water into your baby’s bottle making sure the water level is correct for the feed you’re going to make.

Step 6. Loosely fill the scoop that came with your tin of formula milk and level off with the edge of a clean knife. Always ensure you follow the manufacturer’s instructions.

Step 7. Carefully handle the edge of the teat and put it on the bottle with retaining ring and bottle cap, then gently swirl the bottle until the powder has dissolved. Vigorous shaking increases air bubbles

Step 8. Cool the bottle for your baby by holding the bottle under cold running water.

Step 9. Test the temperature of the feed on the inside of your wrist to ensure it’s at the right temperature, it should feel warm.

Step 10. Pour away any formula milk left in the bottle that hasn’t been used as soon as the feed is finished.

Many new parents consider using the Perfect Prep machines for making up formula. These are not recommended due to lack or evidence around their safety. For more information visit:

• Questions about infant milk safety (First Steps Nutrition Trust)

Always make up your baby’s formula according to the instructions on the tin – adding too much formula may make your baby dehydrated or constipated, too little formula may mean your baby is not getting all its nutritional needs met

Never add anything else to your bottle such as baby rice or sugar.

Microwaves can heat milk unevenly and create hotspots so are not recommended for warming bottles. It is much safer to stand in hot water if needed, or give at room temperature.

Never leave your baby unattended whilst feeding or prop the bottle up with something.

 

Check out this video to see how to make up a formula feed:

Respond to your baby’s feeding cues rather than looking at the clock – this makes feeding a more pleasurable experience for you both. It can be harder to feed a baby when crying and is more stressful for you. You do not need a feeding schedule – this is called responsive feeding and it means following your baby's cues and feeding them when they are hungry.

Although most babies gradually settle into a feeding routine, they vary in how often they want to feed. Feed your baby when they show signs that they are hungry. These may include:

• Baby trying to find something to suck – usually their hands or fingers
• Moving their eyes around
• "Rooting around" or looking for the teat of the bottle
• Starting to wriggle and getting restless
• opening and closing their mouth.

If you can spot these early signs before they start crying for food, your baby will be easier to feed.

Babies tend to feed little and often, so they may not finish their bottle. Never force your baby to finish the bottle – always be led by your baby.

Make sure you’re comfortable and allow plenty of time to feed your baby.

• Hold your baby close to you in a semi-upright position
• Look and talk to your baby during feeding
• Invite your baby to take the teat in their mouth by brushing it against their lips
• Holding your baby’s bottle horizontally rather than upright will allow your baby to pace their feed and pause between swallowing.
• Once your baby is drinking from the bottle the lips should look wide on the teat and your baby should be calmly swallowing milk.
• If your baby starts to spill milk from the sides of their mouth during the feed or slows down with their swallowing this may mean that they would like a break or have had enough.
• You may notice changes in their facial features or arm positions when they need a break or are full. Remove the teat from your baby’s mouth or lower the bottle to give them a break as this pauses the milk flow. Pacing the feed in this way allows your baby’s tummy and brain signals to ‘catch up’ with each other and for the baby to feel full but reducing the risk of overfeeding.
• Avoid forcing your baby to finish their feed, they may only want part of their feed sometimes which is normal.
• When your baby has finished their feed, hold them upright and gently rub or pat their back to help them bring up any wind.

Try not to rush your baby’s feeds – this is a special time and feeding helps to create a close and loving relationship with your baby. This in turn ensures your baby feels calm, secure and comforted and allows their brain development to flourish.

Keeping your baby close to you will help your baby feel safe and secure as they adjust to life outside your womb and it helps you recognise your baby’s feeding cues.

Your baby should be in the same rooms as you for the first 6 months of their life. This will help you with responsive feeding and has also been proven to reduce the risk Sudden Infant Death.

It’s impossible to spoil your baby with love and affection. 

We encourage you to limit the number of people who feed your baby. It’s important for you to get to know your baby’s feeding cues, so you can respond to their feeding needs. 

For more information about responsive feeding.

The amount of formula milk your baby needs will vary as every baby is different.

Newborn babies will only take very small amounts of formula milk because their stomachs are very small and unable to tolerate a large amount of milk.

After your baby’s first week, as a rough guide, they’ll be taking 150-200ml per kg of their weight per day until they’re around the age of 6 months. 

When you start to wean your baby, they’ll take less formula milk as they start to eat more solid foods, this is normal. 

Babies who are getting the right amount of formula milk will generally have 6-8 wet nappies a day, 2 soft yellow stools and will be gaining weight consistently. Speak to your Health Visitor if you have any concerns.

If you are out and about you may need to consider how to manage your feeds. You could try the following options:

• Fill a vacuum flask with boiling water and then measure out the desired amount of formula milk powder in a small dry container. Take a sterile feeding bottle with you and make the feed as needed by your baby.
• Use ready-made formula which is sterile, therefore all you need to take with you is a sterilised feeding bottle.

Formula milks vary in price but are all similar in their nutritional content regardless of whether they are the most expensive or the least expensive. Choose a formula that fits your budget and is easily available for you to buy locally.

You may qualify for Healthy Start scheme  which will also entitle you to free vitamin drops for your baby. Healthy Start is a national means tested scheme to help families give their children the very best start in life. 

If you’re pregnant or have a child under the age of 4 years you could be entitled to a Healthy Start card which will help you buy some basic family foods. You’ll receive weekly ‘top-up’ on your Healthy Start card to the value of around £8.50 (in your babies 1^st year of life) to spend on milk, fresh or frozen fruit and vegetables and infant formula milk. Your vitamin voucher will be attached to your Healthy Start card. These vitamins are available from your local Children’s Centre – for those not entitled to Healthy Start you can purchase them for a very small charge.

The application process for Healthy Start is available online or via email or phone and is straightforward. How to apply.

Formula fed babies will only need a vitamin D supplement when their formula intake drops below 500mls per day – this is because Vitamin D is added to the formula. This is often around 6 months of age when they start eating solid foods.

All babies cry, but colic is described as crying for more than 3 hours a day, 3 days a week for at least 1 week but are otherwise healthy.

They may cry more often in the afternoon and evening.

It may also be colic if, while they are crying:

• It's hard to soothe or settle your baby
• They clench their fists
• They go red in the face
• They bring their knees up to their tummy or arch their back
• Their tummy rumbles or they're very windy

It can start when a baby is a few weeks old. It usually stops by the time they're 3 to 4 months old.

Things to try to soothe your baby:

• Hold or cuddle your baby when they're crying a lot
• Sit or hold your baby upright during feeding to stop them swallowing air
• Wind your baby after feeds
• Gently rock your baby over your shoulder
• Gently rock your baby in their Moses basket or crib, or push them in their pram
• Bath your baby in a warm bath
• Have some gentle white noise like the radio or TV in the background to distract them
• Keep feeding your baby as usual.

Using a sling can be really useful to keep baby close and allow you to get on with a few things! Is there a sling library near you? Or pop along to one of the BABES breastfeeding groups at the Children’s Centres to talk to other mums about them. Always ensure you are using your sling safely! Click here to read how to do so.

Reflux can be quite alarming when a baby brings up milk, or is sick, during or shortly after feeding. It's very common and usually gets better on its own – most babies don’t even need to see a doctor.

Reflux usually starts before a baby is 8 weeks old and gets better by the time they're one.

Symptoms of reflux in babies include:

• bringing up milk or being sick during or shortly after feeding
• coughing or hiccupping when feeding
• being unsettled during feeding
• swallowing or gulping after burping or feeding
• crying and not settling
• not gaining weight as they're not keeping enough food down.

Sometimes babies may have signs of reflux but will not bring up milk or be sick. This is known as silent reflux.

For more information see:

• Reflux in babies (NHS)