Formula Feeding

Here’s a post for our formula-feeding mummies. It may seem like we don’t care about you as many of our posts are about breastfeeding, but that’s not true! Formula feeding is the best choice for many families, so here’s some hints and tips.

How do I choose a type of formula?

Most formulas will be fine for most babies. In general, I advise not choosing “Gold” formulations. These usually have added iron in them, which sounds like a good thing, but this commonly makes babies constipated. By labelling them “gold”, formula companies are hoping that you buy the more expensive version as who wouldn’t choose the best for their baby? But in reality, our babies shouldn’t have too much iron in their diet. Bacteria and viruses thrive on iron in the gut. Breast milk is low in iron (although the iron in it is highly bioavailable) and this helps to reduce the chance of illness in the baby. These days, a healthy pregnancy with a mum who has adequate iron stores, and delayed cord clamping at birth, should allow plenty of iron reserves for babies until they start solids at around 6 months of age.

Babies have different stools when they are on formula – ideally like toothpaste. If your baby’s stools are firmer than this, they are constipated. If this happens, try different brands of formula. S26 can be a little more constipating for some babies. Also make sure that you are making the formula up correctly. The water is added first, then the scoop(s) of powder. Do not pack the powder into the scoop – just scrape the excess off. Adding extra formula to the water will also cause constipation.

For babies with cows milk protein allergy (CMPA), they will often need special formula that is available on prescription. Soy formula can be trialled initially as some babies with CMPA do not react to soy protein. Lactose-free formula is almost never needed, and still has cows milk protein in it. Lactose is the main sugar in breast milk and true lactose intolerance is exceptionally rare in babies. Goat’s milk formula is also not suitable for those babies with CMPA as the proteins are very similar.

The other thing to be aware of, is that there is no need to progress from Stage 1 to Stage 2 and then 3 (Toddler Formula). These different stages of formula were manufactured so that the formula companies could advertise Toddler Formula. Advertising of formula for newborns is prohibited, but advertising “Toddler Formula” is not. So the formula companies manufactured different Stages of formula, in the hope that you will continue to buy these products as your baby grows, as well as providing a product that they can actually advertise. This allows you to get familiar with their brand.

How do I make up a bottle?

Powdered formula has the potential to carry bacteria in it. For this reason, the “gold standard” to making up a bottle is to add freshly boiled water to the bottle (to the level indicated by the number of scoops you will be adding), then add the powder to the boiling water. The boiling water will kill any bacteria. This, of course, seems a little impractical as you then have to wait for the bottle to cool down to drinking temperature before giving it to the baby. Having a screaming baby who is desperate for their bottle is no fun at all!

Another option would be to start with half the amount of boiling water, add your scoops and dissolve formula in boiling water. Then measure out the remaining cooled boiled water and add this to the bottle to bring it to drinking temperature. Experimenting with what mix of boiled and room temperature water is needed to make it the right temperature, may be required. Keep your pre-boiled but cooled water in another container for use throughout the day. The minimum temperature to prepare formula with is 70 degrees (which is about 30 mins after a kettle has boiled). If you prepare in this way, you can keep the bottle for 2 hrs at room temperature, and discard any unused bottle after this time.

You can prepare bottles in advance by using boiling water, mixing in the formula, and storing in the fridge. Bottles can be kept for 24 hrs. To warm the bottle, place the bottle in a container of hot water to heat up, with the water line below the neck of the bottle. Never heat bottles in a microwave as this often creates “hot spots” which can scald the baby.

If you do not have access to boiling water, preparing a bottle using safe room-temperature water is ok, but must be consumed immediately.

How much and when do I give a bottle?

The tins of formula will have a guide as to how much to make up for your baby, and how often, depending on their age. This is a GUIDE ONLY. Just like breastfeeding, you can do cued-care with bottle feeding too. Babies may be hungry one day, and not as hungry the next. They may go through a growth spurt, and need more bottles. They may take more at some parts of the day, and less at others. This is all normal. My advice would be to make up a bottle as per the guide for age; then give via “Paced Bottle Feeding” (see below), which allows titration to appetite. If they are not settled after this, make up more. When they start to dial up again, after 2-4 hrs, offer another feed.

How do I give a bottle?

Paced bottle feeding is the best way to feed a baby a bottle. It allows for the baby to regulate how much to take as per their appetite. It will slow a feed down and reduce over-feeding which can result in excessive spilling after a feed. It helps to mimic how the baby feeds at the breast (which is useful when giving formula as a top-up to breastfeeding). The principles are: use a narrow-neck teat with a slow flow; hold the baby more upright so that the bottle is held horizontal to the floor; allow milk to come into the teat but it doesn’t have to fill it; watch for your baby’s feeding cues during the feed. A really good video on paced bottle feeding is available here.

Lastly, there is no reason why you can’t be just as close to your baby while giving them a bottle. Cuddle them in close to you, and enjoy this special time.


Other resources:

WHO pamphlet on “How to Prepare A Bottle”

“First Steps Nutrition” is an amazing UK resource and includes excellent information about formula for healthcare workers and parents. Although UK-based, most of it is still relevant. 


by Dr Briony Andrew

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